Experiences of American MT

Cynthia's Biography. Copyright 1997 BY Cynthia Ann Lewis cynmail@aol.com. It may be downloaded and/or printed for your own personal use but may not be duplicated or reprinted in any form without written permission from the author. I will answer e-mail questions at cynmail@aol.com, but I will not accept phone calls.

I. INTRODUCTION

This article was written to answer numerous posts on the AOL message boards requesting general information on medical transcription and, in particular, starting a home transcription business. I recently made the transition from MIS corporate executive to home-based medical transcriptionist, and these are the methods I used in my successful venture.

The information and advice offered here are prefaced by a colossal "IN MY OPINION" as they are drawn from my personal experience. There is no single, definitive word of authority on any part of this career. There are as many ways to enter this field as there are entrants, and every working MT has his or her own opinion on the best way to prepare for success.

A few short years ago, transcriptionists were known as "medical secretaries" and depended solely on OJT, a typewriter and a bulky medical dictionary. Now we have state-of-the-art hardware, complex software programs, specialty reference books, CD's and on line resources, and many MT's are certified by a national association, AAMT. Our training today comes from many sources: on the job (still); under tutelage and mentoring by experienced MT's; local community college or vocational school classes; distance learning courses by excellent (and some not-so-excellent) organizations.

The information in this document is a compilation of what I've learned through my own training experience with At-Home Professions, the collective wisdom garnered from many generous online MT's, my three years of MT experience as an independent contractor, plus my previous 35 years of business and writing experience.

There is a great deal of information about medical transcription available to you on the Internet, on AOL and other online services, as well as excellent periodic newsletters and books written especially for independent MT's. If you are considering medical transcription as a career, or if you are already an MT and want to start your own home business, please use this article as JUST ONE PIECE of data in your research... and I wish you good luck with your decision.

Also, please note that while I give some general medical transcription information, the bulk of this material is geared toward a home medical transcription business. Some references are provided at the end of this article, but you are encouraged to also do your own research into your areas of interest.

Medical transcription is the process of producing reports from dictation by medical providers of the details of patient office visits, clinical, radiographic and operative procedures, etc. Virtually every encounter a patient has in the medical arena is documented in some way. Most providers and institutions have formalized this documentation into the patient's medical record through dictation and subsequent transcription. In addition to typing the report into the desired format, transcriptionists also verify the dictation for both medical and English-language accuracy so that the final report is a clear, medically accurate representation of the encounter between patient and provider.

This "verification process" means that the transcriptionist must have a thorough foundation in medical terminology, anatomy, physiology, pharmacology, laboratory tests and values, medical equipment and procedures. In addition, every successful medical transcriptionist will have superior research and English grammar skills, along with excellent computer skills, typing skills and (if you plan to have your own business) some familiarity with business marketing and management. Paying close attention to detail is another quality that is essential in a good medical transcriptionist.

Just having a computer at home and knowing how to type is DEFINITELY NOT ENOUGH to become a working, successful medical transcriptionist.

If you have a clinical background in the medical field you may have a head start, as long as your English knowledge is as broad as your medical knowledge. In my opinion, the real foundation for this field is a love for the English language and outstanding grammar skills. All other necessary knowledge can be "layered" upon this, but if you are weak in the English department, I feel your success would be limited.

As you will verify and often correct the provider's English usage, you need to be CERTAIN that the final structure of each sentence is grammatically correct. You need to know WHY (technically) a comma goes here, but not there; how to make THIS verb or pronoun agree with THAT subject's number and person; the special needs of a compound sentence; and don't forget semicolons, conjunctions, gerunds, modifiers and prepositions!

If you don't love the English language,
If you have to check the dictionary as you sign your name,
If hyphens and apostrophes give you cold chills,
forget medical transcription. It's not for you.

Although medical transcriptionists are not necessarily solitary creatures, this is a solitary job. For most of your day it will be just you, your transcriber (with that voice in your ear), and your computer. This job does not have personal interaction a s would a customer service or medical assistant's job. You may care about "your" patients and pray for their recovery, but you won't see them or speak to them personally. Your part of their medical care is doing your absolute best with every report, every day.

So what do you get in return for your in-depth training and your excellent work? There's no easy answer to the question of compensation in this field. There are services that hire or contract home-based MT's, local transcription services who may also hire or contract MT's, and owner-operator MT's (who may also subcontract work out).

Income varies by geographical area, by employment versus entrepreneurial situation, by your own desire to work full-time, part-time or something in between. A broad range would probably be from $8.00 per hour in a doctor's office in a rural area to $75.00 per hour as an independent (with all related expenses, including "benefits" coming off the top), and even more as a service owner.

While this appears to be an excellent field for those transitioning from another career to working at home, you need to be aware that there can be a "catch-22" in this profession. Because of the difficulty of the work, experience is so valued that it is sometimes difficult for "newbies" to get a job or clients without experience (and of course, how do you get experience without a job or clients?).

Many experienced (and very vocal) MT's on the Internet and online services will flatly state that it is foolish to even attempt to work at home without having spent time in an office or institution or in an apprenticeship program or mentoring situation. They claim that only with an MT angel perched near your listening ear can you make it through the first few difficult months.

Maybe so. I suspect that some of these MT's have not had formal MT training and that they learned transcription through OJT with a helpful pair of ears nearby, and thus they think it's the best way. However, I have a slightly different opinion since I began working at home with my own clients the week I finished my MT training, and have worked full-time-plus since.

I feel that IF you take a reputable MT training course,
and IF you really learn all that the course offers,
and IF you have outstanding English language skills,
and IF you have at least five years' experience in another field (where you had serious responsibilities and acquired real skills),
and IF you have a comprehensive library of references PLUS excellent research skills,
and IF you are 500% committed to building a successful medical transcription business, THEN you can do it.

Those are a lot of "ifs" and they cover a lot of territory, but with persistence, skills, commitment and the courage to follow your dreams, it can be done. There are also quite a few moms with new babies or toddlers who hope that a field such as medical transcription will allow them to supplement their income from home. I can't imagine it myself, but there are several women who participate on AOL and the Internet who do have small children at home and who are successful MT's. I defer to their experience; you'll have to check out their stories on your own. (I have my hands full with Jake, my yellow Labrador....)

GETTING STARTED ON YOUR WAY TO A SUCCESSFUL MEDICAL TRANSCRIPTION HOME BUSINESS.

Once you've made your decision to pursue medical transcription, the very next thing to do is COMMIT YOUR DECISION TO ACTION. You need to define exactly what your future will look like and how you will go about realizing this dream. It's no coincidence t hat the most successful business owners are those who have taken the time to do the next few steps. Think of this process as drawing a map toward your final destination, with each stop along the way anticipated and planned for. Going through this simple process now will keep you from drifting off course and will keep you focused on your goal and your eventual success.

First, write down your final objective, and be specific. "I want to be a medical transcriptionist" is too vague and does not really define what you want your future to look like.

"In two years from today, I will have my own medical transcription business at home that will provide me with the income I need of $___ per year." That's specific. That's real.

Next, list the individual steps it will take to get from "here" to "there." List every single thing you need to do to make your final objective become your new reality.

Of course you will need training, so write it down. Better yet, include the step of investigating the type of training to take.

Do you need to factor in a transition from a current job? Include that statement.

You will probably need to modify your budget to allow for the purchase of business equipment and reference books in addition to paying for your training; include each item.

Will you need to provide additional daycare for your training time? Include it.

Will you need another car when you start your business? Factor it in.

Do you need to also brush up on typing skills, or really learn the inner workings of your computer? Factor in this training also.

Will you need to do minor or major remodeling for a home office? Write it down.

You need every step written down. Be sure to list the steps in logical order that they need to occur.

Next, assign a timeline to each step, and try to be realistic. Remember, you are not only starting your own business, you are also learning a new and difficult profession. It's a big gulp all at once!

Your training will generally take from six months to two years, depending on the course that you choose. Marketing and getting your first client may take another couple of months, and then you need to give yourself a few months to "settle in" to this new profession. Don't count on meeting your final financial goals the first year (although with luck you may do it).

You may not be certain of each step's timeline, but give it your best guess. None of this is written in stone and there are always circumstances that can speed up or delay your progress, but you do want to have your map drawn as clearly as you can.

Although I give a few additional resources at the end of this article, to complete this step you may need to do additional research about the requirements of a home-based medical transcription business.

Next, for any step that will require a financial outlay, write down the TOTAL AMOUNT, and the amount you may be able to pay incrementally. Many training schools allow monthly payments and/or take charge cards. Computer and office equipment can also be p aid for over time if necessary. Be thorough in this step as it can materially affect your business income and profit.

Your final product should be a complete goal sheet of exactly where you want to go, how long it will take you to get there, how much it will cost, and very importantly, what "there" will look like when you attain it.

When you've done all the above steps, go back through and give yourself two things: one, a break, and two, a couple of important celebrations. This is a huge commitment you are making with the promise of a new career and new way of life waiting for you at the end. Plan to take a quick break when you're halfway through your course. Definitely celebrate when you've completed it! And REALLY CELEBRATE when you get that first job or land your first client!

Spend some time reviewing your goal sheet, and by all means discuss it with your family members who will be affected by these changes. When you're ready, MAKE YOUR COMMITMENT to these goals. Keep the goal sheet handy to check your progress and make adjustments as necessary.

When I finished my goal sheet I also made another page that I printed with a huge font, framed and hung in front of my treadmill where I'd see it every day over the course of my transition. This sheet said:

GOAL
COMMITMENT
DISCIPLINE
SUSTAINED EFFORTS
FOLLOW-THROUGH AND FINISH
SUCCESS AND PAYOFF

Keeping this always (literally) in front of my face and referring to my goal sheet frequently not only kept my ultimate objective alive for me, it kept me absolutely focused on the results I was determined to achieve. I also played a mental movie of what my new life would be like on a daily basis. I tried to picture precise details of my new home business and what a typical day would actually consist of, and I was thrilled when it all came true exactly as I pictured it; in fact, it was almost surreal.

III. MEDICAL TRANSCRIPTION TRAINING DECISION

There are a number of options available to those seeking medical transcription training. These include local community college or business/trade school classes; distance learning classes (home study courses) offered by several large and well-known schools; training side-by-side with another transcriptionist; and, possibly, learning it on your own. Unfortunately, the options also include training with shortcut, fly-by-night correspondence schools, so let the buyer beware.

If you are a person who is stimulated and challenged by the presence of other learners, if you learn best with a "live" teacher present to answer questions and give you guidance or coaching, consider a local community college or business/trade school.

If you are self-disciplined enough to follow a home-study curriculum, if you really learn best on your own and prefer to work at your own pace, if your current schedule or responsibilities would not permit you to physically attend classes or if there is not a local school available, consider a distance learning school.

When you research learning opportunities, just be sure that your course will offer ALL of the following:

Medical Terminology;
Acronyms, eponyms, abbreviations;
Anatomy;
Physiology;
Laboratory tests and values;
Medical procedures and equipment;
Drugs;
Transcription formatting;
Ethics of medical transcription;
Research methods and resources;
Brush-up typing (if you need it);
Brush-up English grammar;
Marketing;
MT "business" skills;
Instructor availability, either in person or by phone;
and LOTS of actual transcription practice (including dictation by foreign-accented providers).

Each course that you investigate will be structured somewhat differently and will offer different values; one will suit you better than the others. One course may include a computer, another may include a transcriber, another may offer an apprenticeship program at the conclusion of the course, another may offer some sort of accreditation. Some courses offer employment opportunities or job-placement services. Some courses provide reference materials, others require that you purchase them in addition to the course. Ask about the details of each course. Find the one that gives YOU what YOU want and then investigate it thoroughly. A reputable course will EXPECT that you wish to check with its graduates for references. DO take the time and DO make the effort to call and talk with former students, and be specific in your inquiries. Ask if the course material prepared them to work in the "real world" without a long period of poststudy apprenticeship. Ask if foreign-accented dictation was included (there are many, many foreign doctors practicing in the U.S.). Ask how strong the research training was. This is absolutely critical to your success as a home-based MT. Get a feel for how extensive the actual transcription practice is, and how thorough the anatomy training. Don't ask questions that will yield a one-word answer but start with "can you tell me about...." This is your time and money you are investing -- be sure that you will get value for your investment.

This is a good question to ask on the Internet. You will find many students and former students eager to share their experiences with you.

In my opinion, to be well prepared to work at home, you can't rush through a course. This is one area where you really don't want the "bargain basement" deal. As in everything else in life, you get what you pay for. Much of the terminology, anatomy and physiology learning is done through memorization and you just can't rush the process. You need time to understand what you're learning, and time to cram it into your brain. When it comes to the actual hands-on transcription, you also need time to accustom your hands and brain to work together typing words like "endoscopic retrograde cholangiopancreatography." (You think that happens overnight??) You also need time to build up your transcription speed to the point where you can make the money you expect to make. When you are paid pennies per line, you must type a lot of lines to make the good income you hope for!

Be aware that, although some courses offer a "certificate of completion" and/or claim "accreditation," none offer certification in the American Association for Medical Transcription, the "CMT" that some medical transcriptionists are proud to add to their names. This certification is offered ONLY through AAMT and requires two tests. The general advice is that transcriptionists with less than three years' actual experience should wait for certification. (You are not required to obtain this certification in order to work. Many institutions will pay a slightly higher wage to certified MT's, but many other employers/clients are not aware of either AAMT or the CMT status.

One final word: In my years of participation in MT online exchanges, I have noticed that most of us feel the way that WE prepared for this profession is the best way. Because my experience is with a formalized training, I find it difficult to imagine someone NOT taking a transcription class but instead learning the necessary skills at another MT's knee or on one's own. With the foundation of terminology, etc., that my course provided, I find it hard to understand where that particular knowledge would come from if you are trained one-on-one by another MT. Yet it happens, and those new MT's feel they are well prepared. (This is another area where I yield to others' experience.) It would certainly be a good way to ease into the business once you have a basic knowledge of terminology, etc.

On a personal note, I took a year to finish my home-study course, and I worked full time for most of that year. It was a demanding, exacting course, it was not cheap, but it gave me the results I wanted. You must not expect to be a top-notch medical transcriptionist the day you complete your training. You will "graduate" with entry-level skills, and hopefully this will be just the beginning of your learning experience. This is one of the reasons so many of us find this field so challenging: The learning never stops.

These are a few of the methods I used to supplement my training class and enhance my learning to better prepare me to begin my business right away.

** I switched from my familiar but inadequate word processor to WordPerfect 5.1. Although many transcriptionists use newer versions of WP and many others use Word (or other word processor programs), a huge percentage of MT's use good old WP51+ (the + gives you fax capability). This version is still available for sale new, with manuals. It may not have the graphics and the enhancements that newer word processors have, but it will certainly (with speed and excellence) do the day-to-day production work required. One advantage also is that it runs on smaller, less expensive computers. Currently, (Christmas, 1997), the productivity tools (add-in or related software programs) you need to work at home are available for WP51+; however, they may not always be available. This may be a consideration in your decision as some updated versions of this type of software are not being enhanced for the MS-DOS operating system. The computer world is definitely edging toward the WIN95 operating system environment and those of us wedded to WP51+ will eventually have to upgrade. (I plan to be the last of the last!)

** I studied as much as I could by TYPING THE TERMINOLOGY. While learning medical terminology, I typed each word and its definition into documents and then manipulated the text so I was able to "test" myself constantly by bringing up either the word (and then typing the missing definition from memory) or by bringing up the definition (and typing the missing word). I also made my own voice recordings of both words and definitions and used them in learning to type the missing elements. Both of these meth ods accustomed my fingers and brain to work together long before I was required to try actual transcription. It's a little like learning to play the piano or other musical instrument. Your brain is not the only organ being challenged, and the more practice you get, the better off you are with transcription.

** I used my re-recordings of terminology and definitions while on the treadmill, in my car, while my husband watched racing on TV, or any spare minute that I had around the house. I truly immersed myself in the course work as much as possible and feel I gained a good foundation of basic knowledge this way.

** I supplemented the course anatomy and physiology text with that from a local community college MT course, plus another text my son had used for his paramedic training. While learning each anatomical system, what may not have been covered by one text was certainly taught by one of the others.

** I learned many of the features of WP51 while studying MT so that when I was finished with the course I was also fairly expert with the word processor. This proved to be beneficial when clients asked for "fancy secretarial stuff" in addition to MT work . It's much harder to learn how to produce tables, lines, text enhancements, etc., when you're working against a deadline. It's also very much to your advantage to know how to REALLY use macros -- even the advanced programming macro language features. They truly enhance your productivity (and they take awhile to learn). The backbone of my business income is based on a workers' compensation form I developed for a client that is driven entirely with macros; it was well worth the time it took me to learn this particular feature of WP51.

Supplement your MT study program.

** I purchased a medical online speller utility (Stedman's) while I was still doing the course work. I still learned how to spell all the terminology by using my learning methods as above, but I also produced quality work to send in for grading. You wil l be using the speller as you work for clients and I felt like I wanted my first "work" to be as professional as it would be later on.

IV. PLANNING FOR YOUR FIRST CLIENT / JOB:

As you plan your MT future, here are a few things you should know.

There are distinct "levels of difficulty" in medical transcription work. The most difficult (in my experience) may turn out to be your MT course work! I personally have not encountered anything as hard in the "real world" as the work I was trained on, especially with the foreign-accented dictators the course used. However, I did contract for overflow Discharge Summaries from a local hospital and found the work very rigorous. This particular hospital is a teaching institution so, in addition to unfamiliar procedures, I ran into green residents who used every abbreviation known to the medical world and many that they themselves coined. This is certainly one situation where I agree that you need an experienced MT nearby to help. Generally, hospital w ork is the most difficult transcription. You will have many dictators to get used to; the likelihood of foreign physicians is high; the work itself is harder as there will be unfamiliar procedures, equipment and drugs. Also, you may be asked to meet more administrative requirements than a private office or clinic (methods of billing, patient identifiers and logs, etc.). I was also required to provide an Errors & Omissions insurance policy and sign a contract before I began work for the hospital.

Because many of the long-distance MT services contract with hospitals, you will probably run into these same types of problems and levels of difficulty working for these services. (And, without experience, it's unlikely you will be hired by a service.) Services may also require you to purchase or lease compatible equipment and you may have phone charges involved with obtaining and submitting work. You may either be considered an employee or a statutory employee; in either case, you will be "employed" (as opposed to being a contractor where you are effectively "the boss"). Services may provide some compensation benefits, however, and you may be able to specify the amount of work you prefer to do. You probably won't be able to pick and choose the type of work or the providers for whom you transcribe, although some services are more flexible than others. You will probably be required to undergo some training on the service's methods and equipment, and you will be expected to conform to their style and quality standards.

Back to the local opportunities: You may have fewer dictators and less demanding administrative requirements at outpatient surgery centers (as compared to hospitals), but the work itself would be similar to that of a hospital, without the chronically ill patients, of course.

Large medical groups that provide in-house procedures may have work that seems difficult at first, but these offices also tend to do the same procedures over and over, so once you do the initial research, you should be able to settle in with a degree of expertise. You may have to get sick and DO go on vacations, and often these groups will contract on an ongoing basis to home-based transcriptionists to supplement their in-house staff.

Walk-in urgent care clinics have easy work (in my opinion) and have lots of it, particularly if they service the workers' compensation needs of local employers. Many will require transcribed reports from specialists on contract who take referrals from th e clinics. You may also run into general secretarial work in this environment. As many of these clinics are owned and operated by large chains, once you get your foot in the door you may have more business than you can handle. Be aware that these clini cs often work 364 days a year and will require a similar commitment from you. (This should definitely be determined at the outset, and you have the right to state your own terms.)

Smaller (one, two or three physician) groups or individual doctors may also have what seems like difficult work at first but, again, once you do the initial research you will be comfortable with the repetition. You will also get to know the individual pr oviders' idiosyncrasies well and come to anticipate their next phrase. They (obviously) will not have as much work as the larger groups or clinics, and you will need to have several of these clients to provide full©time work. You will also run into a "f east or famine" work situation with these groups as the doctors may take extended vacations or their patients simply won't schedule elective appointments and procedures at different times during the year. Collections have been known to be a problem with the smaller, leaner offices, and line rates can be the lowest of your local clients.

As you first start out with only entry-level skills and just the course training for experience, you will want to consider working for clients at the "easier" level. Working on your own at home is stressful enough at first without adding the additional pressure of very difficult work. You may also prefer to start work in-house at an office or clinic, or within an apprenticeship program through your course or via a local established MT. Be aware, however, that many employers will not hire a "newbie" MT who has no for©pay experience, a nd many working MT's do not have the time or desire to continue a newbie's training on their own clients' work. Its unfortunate but true that some very ill-prepared newbies have spoiled entry-level positions for the rest of us. Horror stories abound on the Web and message boards from experienced MT's who have kindly tried out newcomers and have been appalled at their lack of training, cavalier attitudes about working, dearth of English skills and overall poor performance. If you are lucky enough to obt ain an apprenticeship or mentored position, you can expect to make about half the usual line rate (or less) during your training. The mentoring MT will have to proof every word of your output including listening to the tapes at times. Frankly, an experienced MT can actually produce the work faster than the time this process will take. Consider yourself lucky at any price to obtain this sort of position. It won't be forever, and you will have invaluable "postgraduate" work under your belt... and , best of all, you can market yourself as "experienced" once you complete this program.

Your job at this point is to figure out which of the above options suits you, and which you will "attack" with your marketing plan. It's not too soon to think about updating your resume, to think about business cards and stationery and to begin "picturin g" yourself in your new daily life as a medical transcriptionist.

When you are about three-quarters of the way through your MT training course, start REALLY planning your home business. My suggested laundry list of "must gets" includes the following, and their rationale is detailed below.

1. A comfortable, practical office.
2. A large desk and appropriate space for reference books.
3. Filing cabinet.
4. Separate phone line(s).
5. Stand-alone fax machine.
6. Good laser printer.
7. Transcriber (that fits local doctors' recorders).
8. A method of data backup.
9. Large, comprehensive reference library.
10. Productivity software.
11. Ergonomically sound chair that fits YOU.
12. Accounting software for your business.
13. Line©counting software for your billing.

YOUR OFFICE AND EQUIPMENT:

You will need to have a "real" office, not just the kitchen table where you've parked your computer and medical dictionary for the duration of your course. Yes, if you HAVE to, you can work anywhere as necessity dictates, and I'm not talking about spending $10,000 on a office to be photographed for Architectural Digest. In my opinion, however, you will need a corner away from the traffic and activity of your home where you can work in quiet and peace. (This is a business, not a hobby!)

You'll need a large desk or work area with space enough to accommodate your reference library (within a quick hand's reach).

You'll require at least one filing cabinet to store paid invoices, bank statements, all the relevant files necessary to running a business, plus copies of your billing sheets and invoices, etc.

You'll need at least one business phone line, and more if you want a separate line for your fax and (possibly) a phone-in dictation system. Of course, you'll need a telephone answering device. (Many MT's don't personally answer the phone while they are wor king but let the machine pick up their calls for them.) Check into one of the combination fax machines that can adapt to a TAD. While your word processing software can send faxes and other software can receive them, you may find it more efficient to have a stand-alone fax machine from the start.

You'll need a good quality printer that can stand up to heavy requirements, but it doesn't have to be the most expensive model. Many clients require laser-quality printing, and most supply their own stationery. Many MT's use ink-jet printers, but many also prefer the actual laser printers. You may even have to have a dot matrix printer available for some clients who use continuous-form documents, but personally I'd wait for this request.

You'll need a good, ergonomically sound chair (probably THE most important item you'll buy), good, nonglare lighting, and adequate heat and air conditioning to be comfortable. Remember, your income will be measured by productivity, and an uncomfortable MT can't produce quality work for very long. Making sure that the ergonomics of your work area suit you can prevent tendinitis and carpal tunnel syndrome from making this a very short career.

I'm assuming you will use the same computer for work that you are using for your MT training, but here's something to think about. As users upgrade to the speed-of-light Pentium systems, there are good, used 486 systems available everywhere for very litt le money. Consider getting one and using it for a true backup system to backup your data on a daily basis, and to use for backup should your main system fail. Just as you don't want to hear excuses from your electric company in an emergency (you want the electric power they've promised to provide), your clients depend on you to maintain the turnaround time you have agreed to. They don't care if your hard drive exploded or if the cat had her kittens on your printer; they care about their work being delivered on time. It's very cheap and easy to establish a link with a second computer and you can have a fail-safe business system for under $1000, including a spare printer. This can be a great marketing advantage for you and can relieve your stress immensely when your main system goes down -- and they all do.

Even if your finances don't allow for an auxiliary system now, you MUST have a proven, efficient method of doing daily backups. This may mean a whole tribe of diskettes, a tape drive, a "Zip" drive or similar device, etc. The data (including your word processor program, productivity software and all associated configuration files as well as confidential client files) on your system is an asset of your company and represents a significant investment of time and money. There is no reason to ever lose data that is older than your most recent backup which should be no longer than eight hours ago (your current workday). There WILL be a time when you have to recover from backup; it's as certain as wrinkles, death and taxes. A savvy business person will only have to load the last backup, and WILL NEVER have to reconstruct data from weeks or months ago. You owe it to yourself and to your clients to be "ready for business" at all times, and a regular backup of your data is the first step in readiness. The second step in providing a secure backup method is TESTING the recovery process. The best time to test is before you have "live" files at risk.

REFERENCE LIBRARY:

I know an in-house transcriptionist whose only reference book is a PDR -- but then, she has 15 years' experience and daily access to all the dictating providers. For someone who is new to the field AND starting a home business where the only source of in formation is YOU, YOU need a complete reference library before you ever solicit work. The ideal is to be able to not only find the mystery word or phrase but verify it, which means redundant resources when possible. Remember, in the view of many exper ienced MT's, you are going out on a skinny limb by starting to work from home without on-the-job experience first. You must provide an excellent safety net for your accuracy, precision and productivity, especially as you start out.

Your references are your most valuable tool of your trade.

Here are my suggestions:

Dorland's Medical Dictionary
Gray's Anatomy (or similar quality anatomy reference)
Medical Phrase Index
Tessier's Surgical Word Book
American Drug Index (or similar quality drug reference)
Merck Manual
Laboratory Test Handbook (Jacobs, Demott, Finley, Horvat, Kasten, Tilzer)
Medical Acronyms, Eponyms & Abbreviations (or similar quality abbreviation book)
A subscription to Monthly Prescribing Reference (for new drugs)
The Gregg Reference Manual (or similar quality English grammar book)
An excellent, complete (huge, expensive) dictionary
and EVERY Stedman's (or HPI) Word Book available. These are generally published by medical specialty. There will be many words for procedures, tests, equipment and general phrases used by each specialist that are unique to the specialty and not found anywhere else on earth except in one of these word books. Trust me, you will NOT be able to transcribe accurately without them.

In addition, you should have a Zip Code book, listings of medical providers if available from your local hospitals, and telephone books to cover all your nearby areas. If your training course has provided good references (such as tables of lab normals, s tyle guides, etc.), organize these into a binder for quick lookup. After three years, I still use some of my class references.

You will not use every book every day and some books will be used maybe once a year. I've always felt that if a particular reference book only gives you one accurate phrase EVER it's paid for itself by helping you produce an accurate, professional report.

Another valuable method to use for your research is the Internet, including online services such as AOL. When all of your in-house references have failed and you are stuck, many of the participants on the message boards will gladly assist you with those garbled words you just can't figure out. Also, be aware that a few will not be as eager to help and may chide you for asking what to them is a "simple" question. As long as you have exhausted your resources and applied a good bit of common sense, don't sweat the rude replies you may get -- just be grateful for the helpful MT's that understand what it's like to be new and nervous.

There are also extensive medical and pharmaceutical web sites that can (eventually) yield the answer although it may take awhile. It's well worth your time to learn where these sites are and how to effectively search the net.

The Internet, including AOL and other online services, also provides great networking resources, with the participants sharing their wisdom, methods, problems, solutions, challenges and encouragement daily. As most of us work alone, it can be a supportive environment and a source of real friendships as well as up-to-date information. In case you are unaware of them, there are some wonderful software programs available to the MT to increase our productivity and accuracy. These are medical spellers and dictionaries that work within your word processor so you can check your spelling, lo ok up words even if you have just a beginning, middle or ending sound, check definitions and plurals without lugging out your 15-pound dictionary, and even count stuff for you.

Also on your list of "must haves" is a word expansion utility program which works within your word processor to increase your typing speed up to 70% and save corresponding wear and tear on your hands, wrists and arms. To my knowledge, these four popular programs are currently favored by working MT's: Flash Forward, Smartype, PRD and Instant Text.

Briefly, these programs work by "filling in" the word or phrase after you type the beginning of that word or phrase or an abbreviation; these phrases and abbreviations are either set up by you or come as part of the software. For instance, if I want to type "the patient" nine thousand times a day, all I do on my system (using Flash) is type tp then add punctuation or press the space bar. Flash fills in "the patient" for me quicker than ever I could type it. I also have all my Word Perfect macros set up within Flash so I never have to use the Alt-F10 key + macro name, but simply type a quick abbreviation.

Each of the word expanders has slightly different features and each has their own advantages and disadvantages. Not all work with all popular word processors, some don't work with Windows, etc. None are very expensive (under $300 generally), and I don't see how anyone could (or would want to) transcribe without one. Research these programs and choose the one you feel would suit you best. If you buy one of the programs that does NOT come with an established word list, you probably don't want to jump th e gun setting up abbreviations too far ahead of your actual work as you will tailor your word lists to each provider. However, you will want to consider your abbreviation schemes carefully and allow for plenty of expansion as both you and your business grow.

OTHER SOFTWARE PROGRAMS:

Your business will require a method to track income and expenses and provide you with year-end tax information and other data you need to know as a business owner/operator. There are many of these programs on the market and most are both inexpensive and readily learned. One word of advice ©© USE the program you buy. Record keeping is absolutely required for every business and there are serious consequences (read: wrath of the IRS!) to NOT knowing and following the rules. It's a good idea to consult wi th a tax accountant as you plan your business. There are many valuable deductions available to you as a business owner, and a good tax person can get you started on the right track.

You will also want to research line-counting software that works with your word processor. There are various ways to bill your clients with the "amount per line" currently the most common and accepted method. A "line" can be any number of characters agreed upon by you and your client, but the standard is usually 65 characters. Most of the popular programs have user-defined parameters to accommodate variances in billing.

You're just about finished with your training course, you've built up some good transcription speed, and you are confident that you will be a success in your new career. Now you're itching to find clients.

Have you decided on your pricing strategy?

It is EXTREMELY important that you know what the rate range is for your particular area and that you set your rates within that range.

It may be tempting to drop them in order to get business or because you are still nervous about your ability to do your first for-pay work. Undercutting the going rate is a bad move no matter what your motivation.

If you are honestly unsure of your transcription abilities at this point, don't solicit business until YOU feel ready. Take a couple of months to practice your heart out, and then begin marketing. In your client's mind, inferior work is not worth ANY am ount of money. They might take the bait you throw them of one, two, three or five cents below the current rate structure, but if you produce error-ridden work, you won't have them for a client for long. Do not let your inexperience lure you into under charging. If there is a range in your area, it's okay to set your rates at the lower end of the scale for now, but NOT UNDER.

Similarly, if you have marketed for a while and have not gained clients, do not let desperation lure you into dropping your rates just to "buy business." The rates in your area probably represent the maximum that the market will bear. Other transcriptio nists have inched up these rates through their excellent product and service and it's to everyone's benefit to keep the rates stable. If you do underbid and get a client on that basis, you'll undoubtedly find that the rate is too low and you'll want to raise it. Or, word of lower rates will get around in your close-knit medical community (EVERYthing gets around sooner or later) and other transcriptionists will be forced to meet the lower rates. Levels of service will drop, client satisfaction will drop -- the list goes on and on.

Instead of causing price wars (like Wal-Mart and K-Mart and Costco do in the retail world when they blast into a marketing area), MT competition should be based on SERVICE, not price. We are on the wrong side of the coin to want to start price wars! The doctors may love it, but you (and I) have a family to feed, right?

You are far better off to stick with the established rate structure and offer your doctors services they want and are willing to pay for.

Your first marketing task, therefore, will be to find out the rate structure for your area. This is not as easy as it may sound. For whatever reason, many MT's are very reluctant to disclose their rates to anyone other than an interested medical office. I asked my personal physician for his transcriptionist's name and for permission to use him as a reference when I called her. She graciously gave me the area's range but did NOT tell me exactly what she billed. Many transcriptionists will not even provide that much so you may have to get creative in your search for this information, but it's information you MUST have before you begin marketing. While you're at it, be sure and find out if they are talking about "a line is a line" pricing or if the 65-character line is standard for your area. Pricing can also be done per character, per word (with an agreement of how many characters constitutes a "word"), per minute of dictation, per page, per hour. It really sounds more complicated than it is, but it is absolutely necessary to be precise when you are discussing your fees with a potential client.

There are many good, in-depth discussions about line lengths and pricing strategies on all of the Internet and online service boards. It's a very popular subject and it's well worth your time to research. Be careful, however, in basing your fees on information you get online, unless it's from someone in your exact area. Line rates range from $.08 - .20 across the U.S., and you need to be in your area's ballpark.

Once you have found out the area's rates, you need to structure your own fee schedule based on those rates. You will probably want to have different rates for different types of transcription or levels of service. Structuring your rates according to lev els of service lets a medical office choose what level they want or need and gives them some control over their costs. You may also need a per©hour rate for work that does not lend itself to being charged by the line, such as creating forms or producing fancy flyers for an office.

For instance, I have different rates for:

48-hour+ turnaround medical transcription (per line);
STAT medical transcription (2-hour turnaround or less) (per line);
24-hour turnaround medical transcription (per line);
General secretarial services (per hour);
STAT general secretarial (per hour);
Forms design and production (per hour);
and so forth. I charge a premium for quicker service and a huge premium for work I really don't like to do and which takes much longer than medical transcription, such as secretarial or forms production. To arrive at these rates, I calculated what I make per hour on average doing medical transcription and then added a premium as an annoyance factor ©© and another premium for stat work. In this particular case since I did not want this work anyway, I didn't care what the going area rate was for this type of work. If you DO want all the work available, be careful in keeping within your competition's range.

Now is the time to decide on what VALUES you will offer your clients, including some freebies, such as free pickup and delivery; archiving their data for a year or two; free reprints; free envelope printing; free daily patient logs; data files returned o n diskettes; weekend availability; 24-hour turnaround; phone-in dictation system; redundant systems, etc.

As a newbie, you should be careful about 24-hour turnaround time until you have a little experience under your belt. Offering it to one client is fine, but if you get three or four clients at once, you will be over your head and unable to meet your prom ises. You will not be working up to speed for at least three-to-four months and overnight transcription may be more than you can handle.

Remember, too, that any agreements you make with your clients remain in effect until one or the other party changes the terms. Don't be so enthusiastic that you offer EVERYTHING "free"; you will have to live with the promises you make for some time. Start out cautiously!

A tried-and-true method for getting MT clients is to send a flyer or brochure with a cover letter to medical offices. These materials do not have to BE expensive, but they should look as professional and attractive as you can make them. There are many software programs and specialty papers available to assist you (and none are very expensive). Many of the specialty papers have coordinating business card blanks, stationery, brochures, etc. PLUS software, so you can produce a very attractive package with a small investment of time and money.

The flyer or brochure should highlight the VALUES you are offering your potential clients... what makes YOUR MT service different, why the office should choose YOU. You may want to bullet these values to make them stand out. Emphasize the benefits of using your service.

Use good design principles on your flyer/brochure with lots of "white space", no clutter, just two or three fonts. Keep the text brief, truthful and powerful. Catch their eye and sell yourself and your service.

Do not quote actual rates in any of your material. The phrase "competitive pricing" should be enough. (Remember, you need to be very specific when discussing rates and you could mislead at this point.)

Your cover letter should be SHORT, professional in appearance and wording, and clever enough (in a grown-up way) to catch the interest of the reader. This is not the place or time for your resume, although you can encapsulate experience and training with a couple of powerful words.
** Don't use the passive voice.
** Don't get wordy, pompous, flamboyant or flippant.
** DO sell yourself and your service to your best advantage, but DO NOT LIE or enhance the truth. If you have no actual MT experience, stress your prior work experience if it's significant and/or relevant, stress your excellent training, but DO NOT claim experience that you don't yet have.

Run the flyer/brochure and the cover letter through your speller and proofread it until you are positive they are PERFECT. Have someone else whose language skills you respect proof it for you for effectiveness, for grammar and spelling, for eye appeal. It's amazing what another pair of educated eyes can see!

You will also need a professional©looking business card, and a Rolodex card is a good idea, also. (Blank Rolodex stock is available, as is business card stock.)

It's also a good idea to produce another "packet" of material to drop off at the office WHEN (not if) you get inquiries from your mailing. This packet could have your resume (one page, please) that mentions your recent MT training and any MT work you've done, in addition to your other work and education experience. I included a sheet of personal references (with the names of all my doctor, dentist and nurse friends). You might want to enclose samples of your most difficult reports from your MT training class -- corrected perfectly, of course -- and perhaps a one-page description of the class highlighting its most impressive features. You may want to include a sheet of "standardized rates" with this packet, but do put a disclaimer that suggests your rates can be negotiable. You may also want to offer a discount to new clients (something like 10% off the first month's invoice). A different cover letter could accompany this packet, directed to the person who called you.

Always, after an interview (even a phone interview), send a note to all with whom you spoke, even if you don't get the job or the contract, to thank them for their time and for the opportunity to speak with them about your business. Leave the door open f or future contacts and ask them to pass your name along to anyone looking for a qualified transcriptionist.

THE MARKETING PROCESS

For my initial mailing, I created a database of all the medical facilities in my area (using the Yellow Pages) then sorted the database by phone number to catch all the medical groups. You may wish to sort by zip code (if you're in a large area) or by sp ecialty, or any other criteria you choose. In addition to M.D.'s, don't forget chiropractors, physical therapy offices, urgent care clinics, hospitals, psychiatrists, etc. Anyone who sees patients and keeps records may need a transcriptionist.

You can either send your material to each individual provider or direct it to the office manager. I have found that the office manager generally makes the hiring/contracting decisions about transcription, but your area may be different so the choice is y ours. You can also call ahead to the office and get the name of the office manager so the mailing can be more personalized, and you can use this information for a more effective follow-up call. (You'll have a better chance at getting through if you ask for the OM by name.)

Some people think that sending 100 letters at one time gives you a better chance of success, but I find that a little scary if you are seeking your first client. The reality is, you will only be able to handle one, possibly two, clients as a brand-new MT, and if you take on more than that, your quality and production will suffer. I sent about 50 letters in three different mailings and got clients from each mailing.

A week or so after your mailing, follow up each letter with a phone call (to either the doctor or the office manager). I dreaded the thought of these calls as I hate the phone and get tongue-tied easily, so I wrote out a little script for myself and practiced it. I made a chart with all the "answers" to any possible question a potential client would likely ask so I wouldn't appear to be fumbling for the answers. I also made a list of reasons a client should hire ME as opposed to using other services in case I needed to do some "selling."

To my surprise, I found that each office manager was very courteous, kind and genuinely interested in my service even if they had no immediate need of a transcriptionist. Many volunteered that they would keep my flyer and Rolodex card on file (and the others I asked to please do so), and I even got a few leads of offices to call who were looking for help. By the way, there's no need for you to keep calling these offices once you get a definitive "sorry, we don't need you." Simply go on to your next batch of names and send another mailing.

Other methods than can help you are:

** Networking among your friends or other transcriptionists. The more people who know you are starting a business the better, and chances are some of your friends will know someone in the local medical community. It never hurts to be able to refer to a mutual friend or acquaintance. Ô ay need some help from a subcontractor, or know an office that needs help.

** Classified ads: I placed a classified ad seeking clients and got a contract with a hospital from the ad as well as the opportunity to talk to many MT's who misunderstood the ad and thought I needed assistance. It's not particularly cheap to do, but if you get a client this way it's worth it.

** Call the local medical society and see if they keep a directory of transcriptionists. If so, ask if you can send them your packet of information to be included in their directory.

** Call each local hospital and speak with the manager of the transcription department. See if they send overflow work out or if they need a home-based transcriptionist to supplement their in-house staff. Also ask about apprenticeship programs if you feel that would be good for you.

** Contact every MT or transcription service listed in the phone book and see if they need overflow help or are otherwise interested in your services.

THE INTERVIEW AND AFTER

When you get a serious inquiry from a potential client, ask to meet the caller in person for an interview to find out their specific needs and to discuss your qualifications and rates. They may push you to quote rates over the phone and you may sometimes have to, but again, be sure you know what they want. It always helps to see a sample of their actual work; this will also help you know the type and depth of their work.

The interview is the time to find out every single detail of their requirements, so you must be prepared with a list of questions for those items that may influence your rate. Here's a starter sample, but you also need to stay on your toes during the int erview to listen for other requirements that may not be here. (It may not be necessary to know some of these items until you land the client, but you will want to know them all before you begin work.)

* Font size required
* Number of printed copies required on a regular basis
* Are referral letters sent to other physicians (with envelopes)
* Is data returned on diskettes
* Turnaround time and the flexibility of their needs
* Number of providers
* Specialized forms or formats (EMG, nerve conduction studies, echocardiograms, etc.)
* Pickup/delivery
* Tape size used
* Billing requirements
* Data archival service required (how long?)
* Editing required and restrictions on editing
* Flagging blanks
* Tapes erased
* Style guide required<>\br> Your printed materials must be top quality, and you should take a hand in controlling the interview. Your goal for the interview should be twofold: get a test tape to try out for them, and be given the opportunity to provide a bid for their work.

If you have not previously dropped off your packet of material (the one with your references, resume and sample reports), now is the time to present it. Stress the best of your past work experience, particularly as it may relate to MT. Talk about your M T training class if possible, stressing the most difficult aspects of it. Don't be intimidated by your lack of for-pay experience: You have had extensive transcription experience through your course; you have covered all major medical specialties; you h ave a broad selection of references at home; you are completely confident that you can provide accurate, professional transcription to suit their needs. And above all, you would love to transcribe a test tape for them so they can see that your abilitie s measure up. A test tape is also a way for you to find out if you can -- or even want to -- do their work. If the provider on the tape is absolutely impossible, you may not want to start out here.

Hopefully you will be able to close the interview with a test tape in your hand, ready to submit the reports along with a bid for their business.

Be sure to return the reports from the test tape within the timeline you agreed on, with every report as absolutely perfect as you can possibly make it. You can attach a sheet explaining your blanks. It may be that they just didn't give you enough info rmation to complete the dictation. You should also prepare a proposal detailing your fees according to what your understanding is of their requirements. Indicate when you are able to start their work, and by all means thank them for their courtesy in al lowing you to interview and transcribe the test dictation.

Then, plan the celebration of landing your first client!

VII. YOUR FIRST CLIENT

There are many people who feel that it's necessary to formalize the agreement with your clients through a contract, and sample contracts are available in the MT literature and on the Internet. If you don't feel this is necessary, you should at least prep are a "Memorandum of Understanding" that specifies every little detail you have discussed with your clients, and maybe some that you forgot to talk about. This doesn't have to be a very involved document but it should be complete, including your payment terms. Be sure that it is reviewed by your contact at the office.

Before you begin their work, organize your hard drive to accommodate each client's data files, backup files and archived files. Set up a paper-file system so you never appear disorganized when talking to a client about their work or their account.

Ask your client for representative reports for every type of dictation you will be doing. Every MT (newbie or experienced) who takes on a new account will have a learning curve while becoming accustomed to the providers' dictation and possibly a new spec ialty. Previously transcribed reports can be lifesavers, and there's nothing at all wrong in asking for these reports. You also need to visualize specific formatting. Place these in plastic covers because you will refer to them frequently.

The first three or four months that you work, you MUST take extreme care with the proofing part of your job. It's a good idea to relisten to the tapes while proofing draft prints. (Proofing on the screen comes MUCH later. Don't take this shortcut now ). Run the document through your speller AFTER you have made changes, as well as before. Take extra time to check every heading, paragraph spacing and other formatting requirements. Check that you've spelled every provider's name correctly (better yet , put each of them in a macro so you don't ever make a mistake). Read over every document after you have made all your changes and think it's perfect. You'll be amazed at the mistakes you find. While clients may be understanding about blanks left in r eports (particularly from a new MT), they will NOT be understanding about spelling, typing or formatting errors. Remember, you are an independent business person (not just a new employee) and your work speaks for you.

This careful verification is the process that takes a newbie so much time -- along with all the research you will be doing. But the care you take now will pay off immediately as your client is thrilled with the quality of your work... and will pay off later as word-of-mouth praise builds your reputation and client base.

Please, forget what your sixth©grade teacher told you and WRITE IN YOUR REFERENCE BOOKS everything that you have had to research. Keep a notebook, card file or computer data file with gems that you find... as well as committing them to memory. You should only ever have to seriously research a term once; after that, you should have it either in your memory or at your fingertips.

As you find terms in word books (which only quote the word and do not give the definition), take the extra time to look up the definition and try to memorize it. This allows you to verify that the usage is correct and gives you confidence in both your re search and the work you produce. Always try to verify the mystery word against two sources. One of the biggest dangers in working by yourself (without a mentor or supervisor) is that you may not know you've made an error but your client will.

While researching, try every vowel or combination of vowel to nail an elusive sound on the tape. Use the wildcard lookups in your online speller and dictionary to help you find the rest of the word. Use your "Monthly Prescribing Reference" to help figure out drugs by looking up the disease or by looking through ALL the drugs under a particular beginning letter. You can figure out lab tests by disease by checking the back of the Laboratory Test Handbook. The Merck Manual can be a huge help these fir st weeks as you wade through unfamiliar diseases, procedures and diagnoses. Gray's Anatomy can lead you by the hand through the most complicated anatomical structures. Keep your training course notes handy and refer to them as you need to check style qu estions or phrasing.

If you have a contact person at your client's office, use him or her sparingly -- after you have exhausted every possibility, including the Internet -- and only if you have been invited to ask questions. Don't expect a lot of feedback from the providers; you will rarely get it. If you are asked to make corrections, do them quickly, humbly, without any explanations. If you find that you are making a lot of mistakes, get help from your training school or on the Internet FAST. Do you very best to clear up misunderstandings, and PAY ATTENTION TO DETAILS. If you are not a detail-oriented person (as I am not), force yourself to go over each and every tiny detail of the client's requirements and work every day before you return their reports. Make a checklist if necessary to be sure you have caught every possibility.

Be sure that you meet every deadline that you have agreed to, and be sure that every encounter with your client is a positive one. Now is not the time to complain about the little cupcakes who staff most medical offices. Do more than your part at first, be as pleasant and friendly as you possibly can, build relationships. Taking in home-baked goodies or flowers or boxes of candy certainly won't hurt, but don't spend a lot of time chitchatting with the office staff just to be pleasant. Their time is valuable, and so is yours.

Be open and accommodating when your client expresses future MT needs and looks to you to fulfill them -- even if it means that you have to learn more of your word processor or computer's capabilities. Meeting a client's needs is what being in business is all about. This is where your service may differentiate you from past transcriptionists they may have used. Sometimes a client's requests may not be within the medical transcription arena but are more of a secretarial nature and you may have to make a personal decision whether or not to expand your horizon. Just be sure that you analyze the effort versus return and that you are paid properly for ALL your work.

VIII. AND THE BEAT GOES ON

Depending on your work load at this time, you can continue marketing your services BUT NOW YOU ARE ABLE TO STATE HONESTLY THAT YOU ARE "EXPERIENCED". If financially possible, try to stay with only one or two clients for at least three months until you ha ve eased into this demanding job and it has become somewhat routine. Add only one new client at a time, always taking the same care with their work as you did with your first account. Each new specialty is difficult to begin with as you will always have that learning curve of research to deal with, but you can do it. Above all, do not become complacent with regard to the quality of your work, and do not take on more work than you can do while maintaining that quality. Your speed will increase over time, but be easy on yourself the first year.

While you have just one or two clients, you may have time to start building your library of macros. As you do the same task two or three times while typing, consider speeding up each process by creating a macro for that task.

If you send referral letters to local physicians for a client, create macros for each physician so you only have to type their name and address once. Devise macros to place these doctors' names/addresses in the inside address of the letter, on the contin uation pages, for "cc:" notations at the end of letters and on envelopes. This alone will save you many, many hours throughout the year.

Start building your dictionary of abbreviations to work within your word expansion utility. The more you enter, the quicker your output will be (and the more money you will make). Don't forget to run your macros from your word expander.

As you add clients to your business, you will find yourself performing a constant juggling act between client demands, the needs of managing your business and personal and family needs. For many of us, it has been relatively easy to expand our business but very difficult to maintain the level of service that expansion requires. If you are one of the lucky MT's whose business and abilities grow quickly, don't work yourself into a corner where all you do with your life is work. Remember the reasons that brought you into medical transcription in the first place (job stress in another field, more time with your kids, the peace of working at home, etc.) and keep those motivations in the forefront of your mind. This takes the same discipline that you needed while training and establishing your business, but it's far more important to your life. If you feel that you are limiting your life by the demands of your business, you can always cut back by dropping a client or cutting back on the amount of overflow work you do.

As an IC (independent contractor), vacations are practically unknown unless you subcontract work out, establish a reciprocal arrangement with another MT to cover each other's clients for absences, or ask your clients to find a temporary (you hope) substitute. In three years, I've only been able to take long weekends off, and I don't have much hope for more than that.

It's one thing to whine and wheedle days off when you are an employee, but when you are in business for yourself, you are expected to fulfill the clients' needs above all. Of course, most will be understanding and try to accommodate you, but NOT at the expense of their own operation.

If you decide to subcontract work out, hire employees or work as a subcontractor yourself, BE SURE you understand the payroll laws of your state and the IRS regarding this issue. There are very specific rules with very severe tax implications governing " employee versus contractor" status.

These are popular subjects on the Internet and message boards, and you would be smart to check other transcriptionists' experience, knowledge and opinions. These issues are definite factors in the ongoing maintenance of your business and the maintenance of your sanity.

I hope this information will be helpful to you in considering medical transcription as a new or transitional career; it can be a very rewarding and challenging field if you are suited to it and committed to it.

I invite you to join the community of medical transcriptionists who participate on various message boards and on the Internet web sites. (If you are very brave, there is also an Internet newsgroup (sci.med.transcription) where the atmosphere is less gentle and the waters get a little bloody in the heat of frequent battles.)

Perhaps when you have a little MT experience under your belt, you will help the newbies who follow uncertainly in your footsteps.

A FEW RESOURCES

WILLIAMS & WILKINS
Source for reference books and MT specialty software
1-800-527-5597
Email: custserve@wwilkins.com

MT MONTHLY
Excellent monthly newsletter, one source for the SUM MT training program and MT references & software
http://www.mtmonthly.com

MT DAILY
Very complete source for MT information, excellent message board, MT training sites, national services, etc.
http://www.mtdaily.com

MT FORUM ON AOL (you must be a member of AOL to access this service).
keyword medical transcription

HEALTH PROFESSIONS INSTITUTE
209-551-2112
Source of SUM MT training, word books
http://www.hpisum.com

AT-HOME PROFESSIONS
(MT Training)
1-800-347-7899 (Tues-Fri)

W.B. SAUNDERS CO.
reference books (Dorland's)
6277 Sea Harbor Dr., Orlando, FL 32887
1-800-545-2522

PMIC
reference books including Medical Phrase Index
1-800-633-7467