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by Pamela Maltzman, guest contributor.  [January 18, 2005]




[]  I've been a practicing medical transcriptionist (MT) for over 15 years. I've been self-employed and have mostly worked for the same medical transcription service for nearly eight years. I got trained on the job at Long Beach Memorial Medical Center, a major teaching hospital in Southern California. They had an experimental MT teaching program for one year only. I'd gotten bits of experience at other businesses (one of which was truly shoddy), but I managed to test for, compete, and win a position as a trainee. Most MTs I've known over the years were also trained on the job.

The American Association for Medical Transcription (AAMT), started a couple of decades ago by Claudia Tessier, has offered a certification test (Certified Medical Transcriptionist, or CMT) for some time now as a voluntary program. They've been trying to persuade MTs that this credential is either necessary or a good thing, and that employers should offer more money for having obtained it. I've not bothered to get any credentialing because it has not seemed necessary. Most MTs I know are not credentialed.

But because many MTs feel threatened by overseas outsourcing (in particular to India), they're now attempting to restrict entry into this field. In August 2004, the AAMT passed a resolution seeking to:


* Make certification mandatory before any person could work at any level of medical transcription; 

* Institute occupational licensing;

* Control the education process (now that on-the-job training is nearly impossible to find) by "approving" educational organizations (private or public) that offer MT training; 

* Obtain tax monies to "help" employers hire new MT program graduates in "internships." Tax monies will also be required to establish credentialing & licensing bureaucracies in all 50 states.

I looked at the Bureau of Labor Statistics website and called the AAMT. As of 2002, there were approximately 101,000 MTs employed in the U.S. The AAMT told me they've about 8,500 members (of all types; i.e., "students," practicing MTs, and corporate and educational members), which includes about 2,000 CMTs.  So their membership is less than 10% of the actual number of MTs.

I guess the AAMT has discovered the joy and excitement of feeding at the public trough. It would be a lot of money and a power coup if they gained the legal right to be the gatekeeper for this occupation. Their certification exam costs about $275 or $195, depending upon whether one is an AAMT member. The certification must be renewed every three years. Membership costs anywhere from $55 to $400 every year, depending on what you are. An individual MT like me would pay $135 a year.

It'd be a lot of money, any way you look at it, if the AAMT succeeds in forcing every MT in the U.S. to get certified. More money yet if we have to be licensed.


Vampire Nation


I am utterly dismayed at this turn of events, although many non-free-market MTs are of course overjoyed. In the name of "protecting" themselves from the overseas competition, they have no qualms telling people such as me that I am no longer welcome in this occupation, and that I will not be able to earn a living unless I jump through their hoops.

The AAMT claims they will not be a union -- but I believe that if they become the sole port of entry/gatekeeper to this occupation, they will be de facto a union.

They claim they want "Standards. We must have standards!" But every place I've ever worked at has had standards. They also test every prospective MT for transcription competence.

I have written letters to the editor of Advance for Health Information Management Magazine about this situation, with copies to the AAMT.

The AAMT is stating that just anybody with a computer can "pose" to be an MT. But the fact is that anybody with a computer, who doesn't also know what they are doing, doesn't last long. The market does work. I know of at least one person who tried it but didn't stay with it, because it turned out that she is not a good speller.

The AAMT ridicules the notion that all one needs is a "fundamental ability to get the job done to the satisfaction of industry employers." That is very nearly a direct quote from the editor of the AAMT Journal.

But I ask, what more is necessary? What more is needed? Satisfying my client (my "boss") who thereby satisfies his clients. My boss gets paid and then pays us. What a concept. Such a deal. It'll never make me rich, but it has given me a decent living.

Years ago, having been a member of the AAMT for about a year, I saw the letters and debates in the AAMT Journal on the issue of the AAMTbecoming a union. Most letters to the editor were in favor of protectionism.

All this is happening at a time when many MTs complain that their compensation is going down, and at a time when many people are feeling extremely burdened by the ever-increasing load of taxes we all pay.

I think this will give impetus to the adoption of voice-recognition software because it'll be cheaper in the long run, even if such software doesn't capture all the nuances and perform the editing which a trained MT performs.

And of course, there's no way to track all the people who might have gone for on-the-job training but aren't going to jump through all the hoops the AAMT is putting in the way.

The head of QA at my boss's office -- herself a CMT -- thinks that the mandatory credentialing / licensing process won't happen within our lifetimes. I am not so sure.

I am contemplating eventually finding another line of work; but in the meantime, I am sticking with medical transcription. It's my best-paying job skill, and I have to say that I have gotten very good at it -- that is, so long as I can hear the dictation!

Copyright © 2005 by Pamela Maltzman.


Pamela Maltzman wants YOUR advice!


1.  Assuming the AAMT is successful in lobbying politicians, does anyone know how long such a process might take to implement in California? Months? Years?

2.  Is there anything I can do to either stop this process, or at least stave it off while I prepare myself for another line of work?

3.  I'm thinking of writing to Tom McClintock, the most high-profile politician I know of in California who is at least sympathetic to libertarian/freemarket values. Is this something worthwhile, or would I just be spitting into the wind?

4.  Is this something the Libertarian Party, or any other libertarian organization, might look into? I've long been uneasy with political action and/or lobbying, but this is one issue where it might be necessary as an act of self-defense.

5.  Any advice or ideas that anyone has, please email me at:


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