When I wrote about how I have funded our indefinite travels, I mentioned working as a medical transcriptionist (MT). Naturally, many people have written me for recommendations or asked about working as an MT. Probably the most common comment is “I can type really well.”
If only it was that easy.
I decided it would be a good idea to write more about working as a medical transcriptionist.
What is it?
Physicians and other medical providers often dictate (a voice recording, usually digital) information about a visit, their findings on an exam, their treatment plan, etc. They send that dictation to an MT who transcribes it into a coherent document. However, it isn’t just about typing and correcting their grammar. It requires a knowledge of not only medical terminology but pharmacology, anatomy, physiology, and so much more.
Being a good typist is just a small part of the whole wider picture.
An MT is producing a medically & legally important document. There have been lawsuits based on transcription errors, including a successful $140 million wrongful death lawsuit that hinged on an error that led to the administration of a lethal dose of insulin to a patient.
An MT doesn’t “just type.”
Examples of headaches
Dictated: “The patient was given 100,000 units of heparin.” While transcribing this, the MT should know that giving 100K units of heparin, especially during an operation, could be lethal. This needs to be flagged for the dictator to review (he meant to say 10,000 units).
Dictated: “The perineal nerve was exposed [during a knee operation].” The MT is expected to know that one would not encounter the perineal nerve during a knee surgery. The physician meant to say “peroneal.”
Dictated: “She is to take Keflex 500 mg…” Normally, this would be just fine; however, earlier in the document it was listed that the patient is allergic to cephalosporins. Keflex is in this class, so it would need to be flagged for review.
These are just some of the issues. Medical transcription is a highly specialized form of technical writing.
Typically, an MT will be paid by production. This means that she will earn a certain rate for every 65-character line she produces. Lately it isn’t uncommon to find MTs who are making 6-7 cents per line. Depending on how productive you are while also maintaining a high level of quality, you could be earning less than minimum wage. At my last company, I was averaging about $16/hour working part time. However, that was clinic work which is a lot less complicated.
Dealing with ESL dictators (people whose native language is something other than English) adds an extra special twist to things, although I’ve had native English speakers who mumbled or mispronounced things so badly that I wanted to rip my hair out.
As much of the MT industry has gone to voice recognition (VR) systems, many MTs find themselves working as editors. Dictation is run through VR and sent to an MT who listens to the original dictation while reviewing the VR document. There are always changes needed as VR is nowhere near perfect. These types of MTs are often looking at about 3 cents per line.
While theoretically this type of document is quicker to go through, most of the MTs I know doing this type of work find they are not making as much as they do when they are doing actual transcription.
Before radiology transcription got swept up by VR, I could easily produce enough to average around $30/hour. They tend to use a lot of the same phrasing over and over, so with an expander program I could type only a few characters and get an entire report that only required small changes.
Those were the days.
Working as an MT while being a digital nomad
At a minimum, you’ll need a laptop or netbook, a foot pedal, special software (usually supplied by the company you’re working with), and a headset. I kept my foot pedal in my daypack when we traveled to reduce the likelihood of it getting lost. Without a foot pedal, you’ll have to press keys on the keyboard to start, stop, pause, etc., and that can really reduce your production. Cut your production, and you cut your pay.
It isn’t always easy to find a place that is quiet enough for you to listen to and hear the dictation, especially if you get a whisperer or a mumbler.
You will need reliable Internet. In Morocco, I had a challenge since our only connection was via a 3G dongle. Usually it wasn’t too bad since the software makes sure you have 3 dictations at a time. I would get my coffee brewing, etc., while downloading the first three jobs. You can work on the next job while it’s taking its sweet time uploading the finished one, so usually there weren’t major kinks.
However, there were times when the dictations were so short that I finished all three while waiting for the first one to finish sending.
Sometimes WiFi can cost quite a bit. Having to pay for broadband or an Internet connection, will cut into your earnings as well. And occasionally you just can’t get a connection.
The other potential bummer is if you are outside the US and experience problems with your foot pedal or computer. Getting a replacement shipped to you could cost a pretty penny. When we were in Australia, a friend express mailed me my new debit card. That cost me around $60. For just an envelope and a fairly weightless card!
While many companies offer a flexible window for you to work within, some need work turned around more quickly or may require you to work between certain hours. If you’ve established you’ll be working a particular schedule that was nice and doable at home, you may find yourself waking up at 2 AM to begin work while traveling.
Future of the industry
MT work is slowly disappearing thanks to international outsourcing, voice recognition, and electronic medical record systems that are “point and click.” It’s tough for me to recommend people invest the time to get the training required to be able to acquire employment in this field because of this.
However, if someone is looking for part-time location-independent work, this could be something that works out well. I think VR will continue to take away jobs, especially clinical and some specialty transcription, but at the same time editors will likely be needed for a long time.
If it isn’t your main source of income, MT could enable you to travel and pretty much live anywhere you want as long as you have electricity and an Internet connection.
How to get started
If you don’t have a lot of medical background, you’ll probably need to go through a medical transcription course first. In the past, some companies offered an on-the-job training situation, but those are pretty rare these days. There are lots of online courses, but I think the one with the best reputation is Andrews School. I don’t know much about them, but I’ve read good things from many people.
Some community colleges and adult education programs offer training as well, so make sure to check local resources.
Do you have any questions about using medical transcription to enable a life as a digital nomad?