The Future Of The Transcription Industry

Recently, my company has been trying to figure out what to do about the fact that the speech recognition software they rolled out 9 months ago has been dismally inadequate (like everyone — except management and their enablers — predicted). Management predicted a 50% increase in work production (and correspondingly cut remuneration by one third), but an employee-initiated study showed that the increase from using speech recognition was only around 15%. So far, management's response has been "clap louder". However, the workforce is definitely clamoring for a change. I doubt that they... we... will get it though; not for a while at least. Not until enough people quit and work doesn't start getting done.

I know some people think that India will eventually take all medical transcription work, but it won't. There may be 1 billion people in that country, but (1) how many of those people speak English at least as well as you or I do, and (2) how many of those people will choose medical transcription as their source of income instead of call center, or programming, or engineering, or teaching, or any of the other hundreds of job opportunities being brought about by our wired world? Not enough to replace tens of thousands of Americans. And, as Thomas Friedman said in his book "The World Is Flat": Indians don't want Americans to make as little money as they do; they want to make as much money as Americans do. Finally, like I said here, the number of medical facilities requiring electronic medical record services is going to skyrocket in the next 5 years, and it is going to be native English speakers (i.e. Americans) who will be meeting that massive demand... but only once it starts paying a livable wage again.

The problem, I've noted to coworkers, is with the marketing departments of the medical transcription industry: They are currently unable to explain to hospitals and other medical facilities that providing medical record services costs a certain amount... especially when those hospitals know what Indians are getting paid. They can't explain that there aren't enough talented Indians to do all the work; they can't explain that some dictation is too difficult for Indians to ever do. Since they fail to convince clients that a certain amount of money is necessary to provide this service, they go ahead and contract for a lower rate, and then look for ways to cut operating costs... speech recognition being the foremost attempt.

There really are only one of two possible outcomes (with outsourcing, as noted above, being unlikely): One, either transcription companies start charging their clients the actual value of the service they provide, and hospitals agree to pay it; or two, that hospitals start doing medical records in-house, and convince doctors to use on-the-fly voice recognition instead of transcription services, thereby increasing the time doctors spend dictating (and editing and correcting) their own medical records... something which is possible, although (as any doctor will tell you) the time doctors spend on administrative work is already a big complaint and opportunity cost among medical professionals. Physician assistants and nurses could be assigned to do this work, but again in terms of real and opportunity costs alike, this may not be any more cost effective than using a transcription service.

So, overall, I think that eventually (with (1) underpaid transcriptionists leaving the industry... at least temporarily, with (2) Indians being too few in number and likely to start demanding more equitable pay in the future, with (3) medical professionals generally being unwilling to shoulder the time and responsibility for medical record production, and with (4) the upcoming boom in demand for electronic medical records) although American medical transcriptionists are having a rough time now, the inequities currently being experienced will correct themselves.

I think that once the economy improves, and alternate and better-paying opportunities for employment begin to entice transcriptionists away from their current positions, hospitals see a better cash flow, and the work load increases... perhaps in the next 24–36 months... the transcription industry will become an employee-driven market.