A crusade for the American medical transcriptionist – what has to be done to keep our jobs?

I have been doing what I do for a very long time now, and over the past ten years have seen more and more of the work I, and so many others, could be doing being sent overseas.


At first, and still some now, I and many others in my profession thought it was for cheap labor.   I am beginning to wonder.  Sure, many think it is cheaper for the medical professionals and health providers to send the dictation overseas for transcription, but when you factor in the amount of money for proofing and editing the work once it is returned, there is no real savings.  As a matter of opinion, I would claim that it is probably more costly when you total up those figures.

So why?

It certainly isn’t because of lack of experienced and talented transcriptionists.  There are tens of thousands of transcriptionists right here that paid tens of thousands of dollars for the education and equipment to handle dictation transcription.  In addition, some of these very same transcriptionist are the ones healthcare providers hire to edit the reports returned by off-shore transcription companies.

So, again, I ask why?

In my opinion, the opportunity to bring transcription back to the US, is a fight I am taking on and work everyday to see a piece of it return.  For me, to think that my entire history, family, health, social, and all identifying information about me, being sent to a faraway place is just horrifying.  For me, thinking of how so many people spend time and money to learn a trade, want to work, only to find that the majority of the work is going overseas is dreadful.   (I could and will say this about ANY work sent offshore, but am holding this particular blog post to transcription.)

What makes this whole topic even more irritating to me is that when someone searches the word ‘transcription’, or ‘transcription news’, or even ‘American transcription’ – 90 percent, if not more, that shows up in that search are articles about off-shoring transcription, offshore transcription companies.  The biggest part of the remaining 10 percent of those same results are US MTs complaining about their work.  (Rest assured, this blog post is not going to do that.  This one tries to answer the question why and at the same time show why you shouldn’t.)

After working so hard to fight the occurrence of off-shoring medical transcription, and doing a little research of my own, opening my own transcription company and dealing with 100s of transcriptionists here in the United States, I think I may have part of the answer – and it won’t be liked by those in my profession – but it is my opinion, and I never hold back when I see a fight worth fighting.  Hell, I am not known to hold back on anything – so why start now.

I think a large part of the reason is the arrogance many seasoned transcriptionist have come to have about their abilities and how they spread that around to the newbies just entering the business.   So much arrogance that they make it difficult themselves for someone to want to consider utilizing them.

Arrogance?  What do I mean?

I certainly do not want to imply we are not absolutely the best people to hire, or that we do not absolutely deserve everything we want.  Doesn’t everyone who spends most of their adult life learning their trade and taking pride in their abilities?

So what do I mean?

I mean that so many US transcriptionists have multiple expectations and demands in order for YOU to hire US.  We want steady work, even if you are slow.  We want higher rates, even if you don’t get it back in your fee workup.  We want to do the reports the way we have always done them, regardless of whether you have your own way of dictating.  We want to decide that what you dictate and how you dictate is food for fodder, and may even change it without understanding your desires and thoughts during the process.  We want to correct those words you “make up”, even if to you and the patient, they are critical.  We want to be considered independent contractors, but want employment benefits.

I mean if the only part of that original search results for American transcription mentioned above shows up with actual US transcriptionist results yet with them complaining about their work – why on earth would anyone want to hire them?  They certainly wouldn’t be considered in any other profession if they were found to be this difficult to work with.

No, it is not all the fault of the US transcriptionist.

No, I don’t think that is the whole picture. I think that many of the medical professionals and hospital systems, even insurance companies, feel that by sending the work off-shore they can (& are) bypassing some of the strict privacy laws and regulations set up here in the US making it easier for them to save a buck – not so much in the actual dictation/transcription/editing process –  but in other administrative areas.

I don’t claim to know the ins and outs of hospital administration and financial burdens they have, but I do have a background in various areas of the medical profession, including medical records, billing, and coding (another profession going overseas), and of course, transcription and do know many of the state and federal laws regarding these areas and HIPAA.  I can see where the money would be saved when regulations can be “ignored” or ‘side-stepped’ when using an off-shore transcription company.


Another problem is that those medical professionals who do not want to off-shore their dictations but are in fact unaware that that is exactly what is happening.  They made contact with an American Transcription Company and thought their work would be done here, but in fact, many of the larger transcription companies send their files overseas so they, too, can save a buck.   Simply checking their website for contact information would provide this information, but some don’t even mention that.  Unless you work or worked there, you would never know.  Unless you do your research, you may never know – unless you’re the editor of the reports or the administrator of the company.


Bringing the transcription work back to the US is going to take much effort.  I know this – I live it everyday.  Others seem to think it’s a matter of just demanding it be done and forcing the government to demand it be done. To some extent this is true.  I would add that it is going to take the patients, whose information is being sent offshore, to push buttons and demand the information stay here.  It is going to take hospital administrators, insurance company executives, and physicians to not only want to have their dictations transcribed here, but incentives be given to them if they do.  You know, those same incentives given to other companies to offshore their work. 


And most importantly, it is going to take the US transcriptionist to understand that either we change the way we think about our own careers, and change the way we think about our potential clients and their responsibilities, and either love what we do enough to do a great job with a little bit more flexibility in our own demands and expectations, and going the extra step to research while completing our work, and continuing our education, to allow others to see that having a US transcriptionist do the job is the best practice for everyone.


Transcription is one, if not the, fastest growing, most in-demand work product of the new millennium.  Imagine the jobs generated if we just kept it here.  Imagine the economic growth for thousands of individuals in the US.  Imagine the ability to add a piece of safety to our personal identity. 


www.clktranscription.com – We love what we do enough to help you save time and money.

5 replies
  1. Jannetta Jones
    Jannetta Jones says:

    I loved this article. You hit all the right points. Thank you for pointing out how some transcriptionist are arrogant and demanding.

    Again, Thank you, thank you, thank you, for this article.

  2. Rebecca Randle
    Rebecca Randle says:

    This is an articulate and well-thought-out article. Thank you for the work you have done on behalf of keeping transcription jobs in America. It is my hope that soon the government will make it even more profitable for transcription services to keep their work at home, both to protect the jobs of highly skilled American transcriptionists and to protect the medical records of patients who were never informed that their information would be sent overseas.

    I have a vested intestest in this mission, also, because I was among a large group of devoted longterm transcription employees that was laid off with no warning when accounts we knew and loved were sent overseas. I was in QA for over 10 years, and I was like a mother hen making sure those accounts were serviced with care.

    I want so much to get back to doing the work I love, the work I do well, but am feeling a certain despair at whether I will be able to find another QA job that allows me to support myself for another 10 years or so.

    I agree with you that some transcription employees in the US may be arrogant, but I believe that there are just as many who bend over backwards trying to be flexible, who put in much more time than they are compensated for, who are sitting at their computers, ready and willing to work and keep their end of the bargain, only to have no work available day after day while the transcription company keeps hiring new transcriptionists. This did not impact me directly as I was paid hourly, but I heard firsthand about the struggles, and it broke my heart. Yes, I understand about the demand for lightning fast turnaround, and the competition being stiff in that area; but is it right to ask people to sit at their computers for hours on end, ready and willing to work, and not compensate them?

    In nearly every other job in America, people are paid for their TIME, because supposedly time is money. In other jobs, if there is no work to do, or even sometimes when there IS work to do, employees can be found playing online, chatting in the break room, etc. Transcriptionists are only paid for what they type. The work that they do is physically and mentally taxing and sometimes takes a permanent toll on the body. That job description doesn’t seem like it would be too appealing to an arrogant person.

    Transcriptionists are also required to not only have a tremendous amount of medical knowledge, but are also required to memorize the Book of Style and pages of detailed account specifics for each of the many facilities for whom they may transcribe. They are required to do research for which they don’t get paid. They deal with sound files filled with static, ESL doctors who can’t be bothered to slow down or speak clearly, and English-speaking doctors who think it’s perfectly fine to dictate while eating or driving their cars or going to the bathroom, with no regard for the person on the other end who is getting paid by the line to try and decipher, like a detective, what is being said.

    I love medicine. I love helping the doctors and the patients, and want more than anything to make a positive contribution to healthcare; however, I think transcription companies made a mistake when they all started trying to undercut one another, and were unwilling to state certain requirements as being necessary in order to deliver a quality product at a reasonable price.

    Instead, many transcription companies have thrown their most valuable asset, their employees, under the bus and have simultaneously taken up an attitude of “what they don’t know won’t hurt them” toward the hospitals, assuming that doctors never really read through the transcribed reports. We were actually told at one point that quality wasn’t nearly as important as perceived quality– that if the hospital wasn’t complaining, everything was fine. It’s hard to feel very supported as a quality assurance person when quality becomes irrelevant to the employer.

    Sorry, I didn’t intend to write this much, but it just makes me so sad when I think about not only those of us hoping to still make a living and a contribution in this industry, but also the welfare of the patients.

    • Judith Hobby
      Judith Hobby says:

      Very well put Rebecca. I agree with everything you said. It will take a very well organized person/group to ever put things back the way they were, as far as all of our work being done back here and not overseas, and I know I probably won’t be here to see it, but hopefully it will happen.

  3. Tamra
    Tamra says:

    I agree with Judith. That was clearly well written. I have been applying for MT jobs for the past two years. I held a position as an MT in WI for 11 years. I have not found a company on the up and up since moving to NC. This topic of sending work overseas is very frustrating. I worked as an MT at home for three years after a physician sent his work overseas. These people held his reports hostage, so I just cannot comprehend why more and more docs are going this route.

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