In the internet marketing world, there's what's known as a flog. A flog is fake weblog. In other words, it looks like a real person writing about real experiences – while promoting a product.

In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What I didn't talk about was flogs.

In the medical transcription world, a flog might look like this:

Hi, my name is Jill. A couple years ago, I was desperate for work I could do at home to make some extra money for our family. A friend of mine told me about medical transcription, so I checked it out and found out it's a great work-at-home career for people like me. I went to XYZ Transcription School and got my certification. When I graduated, I found a job right away and now I'm making extra money while my children are in school. I don't have to pay for daycare, either – by the time they come home from school, my work is done and my house is clean! If you want to work at home, you should sign up today to go to XYZ Transcription School and become a medical transcriptionist, just like I did!

What makes this a flog?

What would make this a flog is if the person who owns the site and posts the entries isn't named Jill, didn't go to XYZ Transcription School (or any other transcription school) and/or isn't working as a transcriptionist – and never has. The site exists solely for the purpose of attracting people who are searching for medical transcription careers, work-at-home careers, etc., convincing these people that medical transcription is a wonderful career and that XYZ Transcription School will do a fabulous job of preparing them for this career – then referring them to XYZ.

Why would they do that?

Because XYZ Transcription School will pay them $ $ $ . This is known as an affiliate arrangement, where you have the advertiser (the MT school) and the publisher (the web site). Depending on the program, they will get paid for a lead (an e-mail address, which is why many of these have a "free" giveaway that requires signing up for a mailing list), a phone call to the school and/or a sale. Most of them pay based on a sale and the amount can be substantial. For example, FutureMT pays $ 160 when an affiliate site sends them someone and a sale is generated.

Don't get me wrong – I'm all for generating revenue. And there's nothing illegal or immoral about affiliates or affiliate ads.

However, not only are flogs immoral (in my opinion) – they are also illegal. And they always have been.

Pity the poor FTC, having to police the internet.

Example of a suspected flog

I came across this site that just practically sat up and announced  "I am probably a flog" to me. Somehow, I really doubt that "Kate Delaney" is really someone who went through the program and now works as an MT. If you send her e-mail and ask her questions about FutureMT, getting a job as a new graduate, is she hiring, who does she work for, how does she like it – you aren't likely to get an answer. Even though her contact page gives an e-mail address and tells you to contact her if you have questions about a medical transcription career, an e-mail I sent 2 weeks ago from a gmail.com mail account still hasn't been answered. Maybe she's busy transcribing.

Or – maybe she's busy doing other stuff because she isn't actually Kate Delaney. Look who owns the domain name: Beth Stefani of Lariat Group. (I'm going to start the timer after I post this and see how long it takes Beth Stefani to make this registration private.)

Now, it's POSSIBLE that "Kate" hired Lariat Group to buy her domain name and manage it for her because teaching businesses how to manage blogs and be profitable is one of the services offered by Lariat Group.  I would hope that if a company like Lariat Group is advising "Kate," they would certainly make sure she complies with the FTC requirements for bloggers and endorsements. But it appears to me that Ms. Stefani gains her expertise for consulting through "hands-on experience running her own network of sites," so I suspect there is no Kate Delaney and that this is actually a site in said "network of sites."

Again let me reiterate – I have absolutely no problem with people putting up websites and trying to make money. Hell – I do that. But in my opinion, what Beth Stefani is doing at this site is immoral. And I guess the FTC agrees with me, because it's also illegal.

FTC Regulations for Bloggers

False advertising has always been illegal, anywhere. The FTC has recently updated its guidelines because flogs have been a real problem on the internet. For one thing, they're lucrative. Imagine if "Kate" can get 10 people a month to sign up with FutureMT – she made $ 1,600. Heck, most legitimate transcriptionists I know would be happy to create a REAL blog for that kind of money!

There's just one catch and that's the FTC's guides concerning the use of endorsements and testimonials in advertising.

When the advertisement represents that the endorser uses the endorsed product, the endorser must have been a bona fide user of it at the time the endorsement was given. Additionally, the advertiser may continue to run the advertisement only so long as it has good reason to believe that the endorser remains a bona fide user of the product.

What does "bona fide use" of an education mean? It means "Kate" not only must have actually done what her "blog" says she did (attended the FutureMT program and graduated), but she must also be working as a medical transcriptionist in order to endorse the product, which is an education that allegedly prepared her to be a medical transcriptionist. Even if "Kate" actually did attend FutureMT, she cannot endorse the product until she is working as an MT. And when she is no longer employed as an MT, she is no longer "using" the product of a medical transcription education.

One of the other requirements the FTC has clarified is that a blogger must disclose material connections with an advertiser, and that disclosure can't be hidden somewhere in the small print – it has to be easily apparent. Even if "Kate Delaney" is a real person who actually graduated from FutureMT and is working as a medical transcriptionist, there is no disclosure anywhere on the site.

When an advertisement is clearly an advertisement – such as a banner ad or Google block (who can possibly mistake those for anything but an ad??), no disclosure is required. Endorsements and testimonials are where people really seem to get into trouble. This is nothing new – the same rules apply for print ads and endorsements, infomercials, television and every other kind of media. For some reason, bloggers thought the rules didn't apply to internet advertising!

Can the advertiser be held responsible for what its affiliates do?

Let's look what the FTC says in their guide:

In order to limit its potential liability, the advertiser should ensure that the advertising service provides guidance and training to its bloggers concerning the need to ensure that statements they make are truthful and substantiated. The advertiser should also monitor bloggers who are being paid to promote its products and take steps necessary to halt the continued publication of deceptive representations when they are discovered.

That looks like a yes to me!

Last but not least – why do I care?

As noted in my last blog post, people who want to join the work-at-home workforce seem to be like cannon fodder – or lemmings. These flog sites are run primarily by people who make their living off affiliate sales and who know how to get to the top of the search engines so they'll be found. They don't care if someone scrapes and saves and spends their last dime to pay the tuition, then scrapes and lives hand-to-mouth during the entire time they complete the course, or that they are depending on the money they will make once they complete it and start their career. All they care about is getting more people to their site because it's a numbers game – more targeted traffic translates to more sales. And that's really what they care about – the sale. You won't find them promoting the best schools – you'll only find them promoting the schools that offer the highest dollar amount to their affiliates. By the time the prospective MT finds it's next to impossible to get that dream job, the affiliate has been paid – and isn't answering e-mails. They also don't care what this does to the industry and how it drags all of us down. First, it was "matchbook schools" we fought – now, it's internet marketers looking for the big-dollar affiliate payouts. I've made a good living from medical transcription all these years. No, I don't recommend it for anyone because of changes in the industry since I started – but I also acknowledge there are people who don't have as many options as I do, who really do need a job that's portable or that they can do at home, for a variety of reasons and not all of them having to do with having children. For those people, medical transcription may still be the best option. I just hate to see them given information based solely upon how much money the person disseminating the information will get if they can make the sale. Even if we believe in "let the buyer beware," the FTC has undertaken these guidelines to protect consumers. And for as long as I give even a small damn for the medical transcription industry, I will continue to try and not only call these people out when I find them, I will also try to outrank them in the search engines so that prospective medical transcriptionists come to sites where they are talking to real medical transcriptionists, not fake ones trying to make a sale.

Now for the disclaimer!

I am not 100% positive that the above-referenced site is a flog, I only suspect it is a flog. Heck, it may be legitimate. I will publicly retract my allegations if Kate Delaney will contact me with proof of her identity, a certificate of graduation from FutureMT and verification of current employment as a medical transcriptionist. As with everything else at MT Exchange, this is just my opinion based upon the facts availableto me at the time of publication.

MT Exchange

The question has been posed to me, on more than one occasion, about the possibility of medical transcriptionists transitioning to the role of a scribe. Every time, this is the article link that gets sent to me: Modern Healthcare – Docs using scribes to ease EHR transition. (This requires a login to Modern Healthcare; registration is free.) The company being discussed in the article is ScribeAmerica.

So here’s officially what I think.

On the surface, this appears to be a good job for a medical transcriptionist. I see several obstacles, however, to viewing this as the saving grace of a dying career.

Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.

“It’s not hard to find scribes,” she said. “The program has a 300-person waiting list.”

The majority of the current medical transcription workforce isn’t composed of college graduates. If a college degree becomes a requirement or a preference for scribing jobs – and based on this statement by ScribeAmerica, it looks to be heading in that direction – the majority of MTs would not be candidates for these jobs.

That’s not to say it should be ruled out as an option. It’s quite possible that, given the skill set medical transcriptionists possess and how it applies to the scribing position, the preference or requirement for a college degree would be waived. The articles says that about 30% of its hires are people with secretarial backgrounds.  It’s certainly worth a shot for any MT who is interested in doing this kind of work in order to transition out of medical transcription.

Speaking of the skill set, I read this paragraph and wondered how much of the skill set is actually the same:

Esquibel said there is “a very strong correlation” between eventual success as a scribe and a candidate’s prior successful work experience in service-sector jobs, particularly as a waiter or a waitress. “There are a lot of the same patterns,” she said, in keeping multiple food and drink orders straight in a restaurant and keeping tasks and records straight in a busy ER.

Transcriptionists sit in a (preferably) quiet room and do one thing – they transcribe. One could argue that working at home requires multitasking, but it simply isn’t conducive to productivity in transcription. There aren’t many things you can do while transcribing, and be productive/accurate.

However, one of the biggest obstacles I see in medical transcriptionists transitioning to scribing is the fact that it is an in-office job. Traditionally, the allure of medical transcription has been that it is a job that can be performed from home, on a fairly flexible schedule. It’s ideal for people who:

• are caretakers for children and/or adults
• have health problems that preclude working in an office but can be accommodated in the home office environment
• live in rural areas where there aren’t a lot of job opportunities
• move around frequently and need “portable” jobs (i.e., military spouses)

All of these advantages go away with the scribing position. It absolutely requires that the scribe go to where the physician practices medicine. In my opinion, that’s going to eliminate many current MTs who might otherwise be interested in this as a career.

Even supposing that the issues of caring for children and/or other adults are removed, I know a lot of MTs who say the ability to work at home has provided them with the only available option to make money, given their rural location and lack of local job opportunities.

Then there’s the pay rate…

Although there are plenty of jobs in healthcare and the job outlook in healthcare continues to be good, there’s not a lot of money in healthcare

Starting pay for a rookie scribe is about $ 10 an hour, she said, while chief scribes make $ 14 to $ 16 an hour.

OK, first of all – it’s better than no job at all, right? Second of all, I know MTs who make about that. The big HOWEVER is – they’re making that while working at home, not having to go into a hospital (where most of these jobs are based).

Those are the obstacles I see to current medical transcriptionists transitioning to the scribing career. The other obstacles require me to take out my crystal ball and making some predictions about the future.

Prediction #1: Technology always gets better. That’s not a crystal ball prediction, it’s a fact. Therefore, it stands to reason that EMR software will continue to improve in functionality. Hardware will continue to improve. The two put together will be more intuitive and easy to use. (Consider Apple’s iPad a major game changer – the healthcare technology forums are going crazy over what it will mean for mobile healthcare and EMRs.) As software and hardware improve, it will be easier and easier for doctors to use the technology without assistance.

Prediction #2: I think the demand for scribes will decrease as older doctors retire and are replaced more and more by doctors who can’t remember what life without a computer is like. Keep in mind that the youngest doctors already in practice probably remember not having a PC at home, but likely had one by the time they were in their teen years, depending on their family circumstances. Medical students currently close to graduation are very likely to do their internships and fellowships at hospitals that already have EMR technology. The “computer generation” of doctors will be comfortable with technology, likely more so than with dictating.

Prediction #3: Whether or not hospital  and clinics are going to want to add the expense of scribes will depend on how much they see billings drop as a result of doctors trying to deal with the documentation on their own, and how much value the scribes add and whether that all balances out. It appears to me from the article and the ScribeAmerica website that they’re specializing in ERs and in EMR transition. Is there longevity in a service that’s offered on such a limited basis; and, in the case of EHR transition, for a finite period of time – will healthcare providers be willing to continue the expense of a scribe post-EHR transition?

Medical transcriptionist to scribe

I think for MTs looking to transition to a different career, the decision to become a scribe depends on a number of things. First and foremost would be whether you are able or willing to work in an office, and whether you live in an area where this kind of job is available (or other jobs that are just as good or better).

Second, do you want to transition to a career that doesn’t pay much better (or any better) than MT and may be just as short-lived? If you believe my predictions are fairly accurate, then you’re looking at a career life that’s approximately equal to MT. It might be worthwhile if no additional expense for schooling is necessary.

Since the article states they have difficulty finding people who will stay or can do the job, I have to wonder if the same inverse supply-and-demand that has resulted in stagnant pay in medical transcription is going to take place in scribing as well. The pay rate doesn’t seem to be in alignment with the statement that good people are difficult to find and keep. Maybe there’s a lesson there that ScribeAmerica needs to learn, or maybe its due to the financial constraints of healthcare being in play again, I’m not sure.

While I just don’t see this as being a promising transition career in the long term, I think whether or not it’s a better option than MT will depend largely on the individual circumstances of the MT.

MT Exchange

You know you’ve really made the big time when your blog starts getting spammed by spammers who are actually on topic. That means your blog is ranking well for targeted search terms; in my case, that would be medical transcription.

I’d like to thank all the spammers out there who have tried everything imaginable to get their spammy medical transcription links on my blog pages. Now – cut it out.

Thank you. Have a nice holiday.

MT Exchange

I recently received an e-mail from a transcriptionist who described a situation that I think will surprise most medical transcriptionists. It’s an issue I found especially interesting in light of a post by Nae at MT Chat, and the responses it got: Yep, my ESP is working real well today doc …

I hadn’t even discussed this with Nae, so when she posted that thread, she was not aware of this MT’s e-mail to me.

Let me preface this by saying there are usually 2 sides to a story and I only have one, so my conclusions are going to be based on that. I’m not going to name names, but if any MTSOs have had a similar experience from their side, or if you’re in management and you think this is your company, I’d like to hear the “other” side.

In a nutshell, an MT who was being paid a premium line rate because of her experience and skills on multiple accounts, was demoted due to “potential reportable events” (PREs) involving privacy and security breaches.

The reason? Selecting the wrong doctor as attending, and sending a copy to the wrong physician. In the first case, the error was noted by the MT, but too late – the report had already been sent in, at which point it was immediately distributed. Even though the MT sent an e-mail, noting the error, this error was counted in the disciplinary action that was taken against her. In the second instance, the name dictated sounded almost exactly like another name – and the MT selected the incorrect name.

As amusing as it is to say “we can’t read your mind, doc,” I’m wondering if some of the people responding to that post at MT Chat want to rethink their answer. Although Nae’s example is “send a copy to Dr. Patel,” in a case where there are multiple doctors with that name, it could have easily been “send a copy to Dr. Smith,” where there are not only multiple Dr. Smiths on a list, but Dr. Smyth, Smythe and etc. All it takes is one large university hospital or VA account to realize there are many, many ways to spell names we all thought had a common spelling, for both patients and physicians. With no training and no physician list, it would be obvious to an MT that picking the correct one among a number of Dr. Patels is impossible and needs to be flagged to QA – but what about Dr. Carter v. Karter? If someone says “send a copy to John Carter” and you find a John Carter on the roster – would you look any further to see if there was also a John Karter and therefore flag the report to someone up the food chain?

In my opinion, there were a couple of errors that occurred prior to the MT making the error.

1. It was a new account and no training was given.
2. No physician list was provided, including a list of attendings and their fellows or residents.
3. The MT company has no written policy regarding PREs and how they will be handled.
4. The MT company has no written policy regarding disciplinary action to be taken in the case of MT errors of this kind.
5. No software safeguards are in place.
6. As is usually the case, training for dictators at the facility also appears to be substandard – GIGO.

Some of these seem like no-brainers, don’t they? I don’t know how anyone can be expected to perform with minimal errors on a new account without any direction or instructions, regardless of how experienced they are. An experienced MT may be able to pick up and transcribe any dictator at any facility – but years of experience is going to give an MT the ability to somehow instinctively grasp account specifics.

This is not a small company, this MT is not an independent contractor. The disciplinary action taken cut the MT’s pay by 20% to 25% yet there’s no written policy in place. No inservice on HIPAA, no training on the account, no written disciplinary policy – but with no warning, the company takes action that cuts pay 25%.

Hello, MT employees – have you asked your employer what the written policy is for your company? What happens when a mistake like this happens? What are your responsibilities? What disciplinary action may be taken against you? What recourse do you have?

Technology being what it is, why doesn’t the EMR software – that same software that immediately routes the transcript to all interested parties upon completion by the MT unless it’s flagged – have some safeguards built in? I realize that EMR technology is evolving, but is anyone doing anything to ensure that copies don’t go to Dr. Carter if he’s not involved in the patient’s care and Dr. Karter is? If not, why not? You’d think that while everyone is out spending money on streamlining the process and reducing labor costs, they’d also be doing something to ensure security is more automated. Even a delay of a certain number of minutes would be helpful (something like the 7-second delay on newscasts), so if errors are caught shortly after the report is completed, there’s some hope of rerouting it before it’s gone out for distribution.

Are MTs paid enough to take on this kind of responsibility? Are YOU paid enough to take on this kind of responsibility? What I see happening is that more and more MTs will send every questionable physician name to QA or to the hospital staff to deal with. Then, someone will get mad – probably at the MTs. Because it seems nobody is willing to hold the dictators responsible. So here’s a tip for all you working MTs out there – unless you’re 100% certain, flag that report. The sooner these questions start piling up on the desks of people who are actually paid enough to deal with PREs, the sooner the problem will be resolved.

This situation was a FAIL of epic proportions, primarily on the part of the transcription service for not having policies in place, by not having in-service sessions for employees to train in HIPAA compliance and on account specifics. Well, shame on management for taking its shortcomings out on the transcriptionist.

MT Exchange

In the internet marketing world, there's what's known as a flog. A flog is fake weblog. In other words, it looks like a real person writing about real experiences – while promoting a product.
In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What [...]
MT Exchange