28 Jun 2003
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Tackling the offshore outsourcing backlash (II)

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Dear Friends,

I am posting a mail I received regarding this:
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Dear Amit:

I must reply to some of those individuals who seem to think that the MT business is the "Miracle" for making money. If there is any money to be made in this industry it will only be those who are at the top and often they have to take cuts as well.

There are no "short-cuts" in training and often some individuals believe that all they need is to purchase the SUM Training Program or some other fastpace program and they will be "in the money". The reality is that the medical transcription business is a hard business and competition is at it's highest. There are no short cuts and certainly no fast track to wealth.

I have been in this industry for over 30 years and have seen many MTs companies come and go or be gobbled up by a large service to keep out competition at a lower price.

The "Hot Steam" to train offshore MTs is still questionable. Many MTs in the U.S. are without jobs and this can only hurt the
industry overall. IF the offshore mpanies, with U.S. based offices continue, I am certain that our U.S. Senators and U.S.
Representatives will get a stream of hot letters and phone calls. Then things will change.

As always we in the U.S. have not learned to fix our problems where the problem exists. Offshore transcription is being done to cut costs to the service owner, but the service owner is still making the money and the MTs are being shortchanged, especially here in the U.S. Many of us who have been in this industry for years and
years and have helped to grow the industry are now without employment ourselves. If this continues at the rate it is going,
you can be assured that the U.S. MTs will rise up and go straight
to Washington, D.C.

I know that we are in a global economy but the fact remains there are many MTs in the U.S. who are out of work and if they are
working they are still being paid wages that they were paid 10 years ago.

We have Indians who have come to the U.S. and make their homes here as well as some become U.S. Citizens. They go into business here in this country only to turn around and send the work back to India. Well there is a saying here in this country and that is "Don't bite the hand that feeds you".

Having been to India on three separate occasions to train MTs, I am well aware of the brilliant minds and the adeptness to medical transcription. It also offers an avenue to bring living standards up to many of your citizens. However, when U.S. highly skilled and trained MTs are without positions or jobs something has to be done
to alter the scales. I believe that there is room for all and there is a "middle ground", unfortunately for the U.S. MTs, BIG
BUSINESS took a look at the revenues and decided that this was the industry to get into. I have never believed that the revenues that have been bantered about are real and that they are highly inflated.

I am not against India's business of medical transcription but I am against U.S. MTs losing their jobs and perhaps it's time for all of us in the U.S. to stand up and be counted.

Stella J. Olson, CMT, FAAMT
U.S.,A.
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Do make time to email your views. I can understand the problem, but
I am missing the solution...

Cheers!

Maj (Dr.) Amit Chatterjee, SM
Strategist / Founder ~ mailto:amit@mtindia.org
MT India ~ www.mtindia.org
"The Community of MT Professionals"
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NEWS AND VIEWS :
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1) Medical Transcription Centers get service tax exemption

The Finance Ministry has said that the eight per cent tax on new services announced in the 2003-04 Union Budget would be effective July 1, 2003 even as it clarified that services provided by call
centres (i.e. commercial concerns which provides assistance, help or information, through telephone, on behalf of another person) and medical transcription centers (i.e. commercial concerns which
transcribe medical history, treatment, medical observations and the like) will be `fully exempted' from the eight per cent levy.
http://in.biz.yahoo.com/030621/77/25cdl.html

2) Vajpayee's pouts Indian IT strength at Shanghai

Apart from on-site software development, Indian companies have ventured into IT-enabled services such as call centres, medical transcription, data digitisation, legal databases and animation. More than 500 portals are being launched in India every month.

The Prime Minister told the gathering of Chinese IT businessmen,that China, one of the world leaders in computer hardware, could benefit from the Indian success in the software industry. "In combination, rather than in competition, Indian and Chinese IT industries can be a potent force," he said.
http://in.news.yahoo.com/030626/58/25gxj.html

3) Unravelling information & communications technology

Enter the ICT department. Thanks to their expertise - and the services of a company called DictaScribe - consultants are able to
dictate letters into a digital recorder and send their words via computer to be transcribed in (believe it or not) India and New Zealand.

One of the team of staff employed by DictaScribe in those two countries listens to the dictation and types the letters on screen. The transcriptions are returned via e-mail within 24 hours, ready to be printed out, checked for accuracy and signed.

The system is currently used by six consultants and a nurse in the GOSH Clinical Genetics department, where difficulties in recruiting medical secretaries had been causing long administrative delays. "We've been doing it for about six month's," explains Dr Elisabeth Rosser, Consultant and Lead Clinician in the department and an
enthusiastic advocate of the arrangement. "The accuracy is superb
and the turnaround time is excellent," she says. The ICT department worked with the NHS Information Authority to ensure that the systemprotects patient confidentiality.

Dr Rosser stresses that there remains a role for medical secretaries in hospitals even under a system like that operated by
DictaScribe. "Instead of spending 60 to 70 per cent of their time typing, they can spend time on filing, pulling patient notes and preparing clinics," she says.

DictaScribe says any accusation that it is exploiting workers in India is misplaced. "In India, medical transcription is regarded as a first-rate career and is greatly sought after. Many transcribers
are graduates and all are highly trained in medical transcription,"the company says.
http://www.ich.ucl.ac.uk/roundabout/2003/april/ict.html

4) IFC makes additional investment in Spryance

The International Finance Corporation (IFC), the private sector development arm of the World Bank Group, will invest up to US$1 million in an existing portfolio company, Spryance, Inc., a provider of outsourced medical transcription services in India. This investment follows a previous equity investment of $2 million
in Spryance, Inc. by IFC in November 2000.

IFC's investment will help Spryance build additional capacity in India and continue to develop its technology platform. Spryance's innovative business model allows its team of medical transcriptionists (MTs) to work remotely out of their homes.
Through the company's technology platform, MTs can efficiently interface with customers and the company to provide a 24 hour turnaround time.
http://lnweb18.worldbank.org/ict/resources.nsf/InfoResources/A77B26
9E4131A94C85256C830052CAB2

5) IT centers to boost jobs in North East

The department for Development of North Eastern Region (DONER) has planned to set up training centers for information
technology-enabled services in all states of the region.

DONER has identified the fact that the "English-speaking ability of
the youths from the region could be meaningfully utilised in services related to information technology like call centers and medical transcription where fluency in speaking and understanding the language is essential".

The courses, which will be offered at a subsidised rate of Rs 3,000 per student, will be spread over eight weeks. The modules comprise both classroom and laboratory sessions. A recent study by the
NASSCOM has shown a severe manpower shortage in the sector.
http://in.news.yahoo.com/030626/58/25gwl.html
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Thank you for your interest in MT India!

The MTIndia Team

[ 06-30-2003: Message edited by: Mike ]

Stella has been in the vanguard of offshore proponents for as long as I can remember. She is the one I remember standing up at AAMT meetings making the case for the position of neutrality AAMT followed...even in the face of the members quite plainly asking that this policy be reconsidered from the floor of the HOD not too terribly long ago. Stella is the one I remember making the plea for American MTs to share their skills and expertise with offshore services and individual MTs because there was room for all...

And I have to admit the not very nice part of me wants to say...it is a little too late to start crying foul now after one has spent the last several years holding the hen house door open...

The more reaonsable part of me wonders if anyone has shared the membership list from the India Caucaus members of the U.S. Congress that can be found in another thread here in the HZ with her.

Nae

[ 06-30-2003: Message edited by: Nae ]

Mike, good question. I believe that 100% turn-abouts usually occur when something can be personally gained from that action. Or, when something you have personally gained FROM (to the detriment of others) is about to come back and bite you.

Overall, I think MT going offshore was going to happen, with or without help from ones in the American MT industry. BUT, I think it would have taken longer with more of a struggle, and just perhaps it would not have slammed us in the face with as much force.

AND, had it not been so embraced by AAMT by doing nothing (inaction is a way of giving support because no energy is given to halt it), the "lag time" could have been used to:
1. ACTIVELY promote the value of US MTs to employers.
2. ACTIVELY Create and stand behind standards of MT education.
3. ACTIVELY Develop and stand behind standards for MT employment within the US
4. ACTIVELY prepare MTs for the eventuality of globalization of their job and how the EDUCATED MT can adapt the skills to survive and thrive
5. ACTIVELY Stand behind correct LEGAL classification of MTs in the workplace, for officers of AAMT and corporate sponsors of AAMT

As it is, the MT industry has no cohesiveness or solidarity. It was and remains ripe for disintegration because in the US from the 1 person IC to the employer of 9,000+ MTs, everyone can do exactly what they want-----charge what they want, count lines as they want, classify MTs as they want, teach MTs as they want, use whatever software they want.....

Meanwhile, in a previous MTIndia newsletter, India itself recognizes MT as a 2 to 6 billion dollar industry, that may end up putting added revenues of 8% into the Indian gov. if MT falls within the "taxable" category. This would be great news for the US MT industry, as the pricing chasm between US and India would begin to be equalized.

Yes, the collective "we" certainly had a great hand in "teaching India how to fish"; now they have fishing fleets and we are left on shore with worms on our hooks.
Carole/gmts

I believe Stella was wrong to teach those who had it as their express purpose to take our jobs away from us.

I also believe that she is right to have admitted her error.

Stella is a bright, energetic woman who is capable of speaking out for us on this subject. I can now be in her corner. Go Stella!

If I were you, I'd ask her directly.

(Edited by Nae to remove personal email addy...I emailed you Gaile )

[ 07-01-2003: Message edited by: Nae ]

I happen to like Stella a lot...but I can't help this gut feeling that her protests are coming along far, far too late....where exactly was she a couple of years ago when many of us were saying what she is saying now....she was the one standing in front of us telling us to our faces tough luck...adapt or get out of the business.

I am sorry Linda, I did not really think she admitting she was wrong about anything in that newsletter post... but I did come away from reading it with the strong sense that these folks have taken what Stella voluntarily (for a fee) chose to teach them and learned their lessons well...they no longer need her to teach them.

The genie is out of the bottle...she helped pull that cork out with both hands. While she was doing that many MTSOs did just what she told us to do...adapt. I think she is going to have to take her own advice and start adapting because I don't think we could force that cork back in the bottle with sledgehammer now.

Nae

[ 07-01-2003: Message edited by: Nae ]

[ 07-01-2003: Message edited by: Nae ]

Carole/gmts

By the way, I haven't adapted.

[ 07-01-2003: Message edited by: Linda Andrews CMT ]

Any further comments I have about this will be sent to MT India, as that's where Stella's letter was published.

As for the reasons, I would suspect that her business has lost some major account(s) to India.

Was it my grandmother who always warned me, "Beware of what you ask/wish for"?

[ 07-01-2003: Message edited by: Gaile Stevens, RHIT ]

That is what makes us all so unique We all look at things differently.

While you may not have had to adapt, there are many U.S. MTSOs (who employ your students) and individual MTs who have adapted in order to stay in business during the onslaught of offshore companies telling the client they could work far cheaper than anyone in the U.S.

Those folks had no other option but to adapt because of pressures brought to bear on them only in part by the business practices of the offshore community. Personally I think the most pressure has come internally from the rapid changes of technology; increasing automation of much of the tradiational transcriptionist role, particularly in the easy specialties like ER, radiology dictation, office clinic notes; back end speech recognition; the push for universal EMRs; and, if truth be told in part because of a perceived lack of support for their attempt to hold firm against these pressures by the organizations that were supposed to be there to help them. When I look at the programs for the annual meetings for both MTIA and AAMT they are filled with seminars on offshore services and how to use them, work with them, incorporate them in the business plan, right next to the seminars on using technology effectively to cut down the need for as many MTs on staff.

Given her long-time, highly visible and vocal role as a proponent of offshore services I think it is asking a bit much to expect those people who were encouraged to embrace offshore by Stella herself to be happy campers right now ... or to ask them not to view this apparent about-face with some very justified scepticism...

But then we all know I am the most cynical one in the bunch around here, with the exception of maybe George

Nae

No problemo Gaile, I just wanted to make sure you knew why I did take it out. Stella is perfectly capable of standing up for herself, it is something I have always admired about her...but it should be her choice where to do so, not because all kinds of folks came out of the woodwork and flooded her email with goodness knows what I figure if someone wants to talk to her seriously enough to do a Google search then they are more likely to be engaging her in intelligent conversation

[ 07-01-2003: Message edited by: Nae ]

I will post the exact date, time and place here, there and everywhere once she and I have nailed it down. Everyone is invited, but you have to keep it civil, 'kay?

Jay

Be sure you let us know.

Nae