Thoughts on Credentialing

I have been so lucky throughout my career in that I have rarely been in a place where I was absolutely biding my time to get out.  I have had my difficult days and even difficult times.  I think that is true in every job situation, no matter how well you might like the job. 

An incident that really stands out for me is when I became a certified medical transcriptionist (CMT).  The American Association for Medical Transcription (AAMT, now AHDI) was established in 1978 by a group of MTs in California wanting to get our profession out into the light, so to speak, because at that time (and still somewhat true today), no one knew who we were, what we did, or how we did it.  We were stuck in most basements of hospitals with little more than a tattered medical dictionary, and that treasured reference was often shared with the other MTs.  One of the first things these MTs did was to send out flyers about this new professional association.  One of my co-workers happened to see this flyer sitting on the desk of our supervisor and asked if she could see it.  Turns out, she had gotten several and had always thrown them away, never bothering to ask the rest of us if we would be interested in finding out more about this association.  Thankfully, she at least did not care if we took a look at this flyer. 

I have mentioned previously about my mentor, Betty, whom I worked with for 11 years.  She was very interested in this association, so a small group of us worked together to form the first local chapter of AAMT, which became GAC, the Greater Akron Chapter of AAMT.  It was a very successful meeting, with the President of AAMT attending and several MTs in the area signing up to become members.  We started having monthly chapter meetings shortly thereafter. 

One of the first accomplishments of the association was the creation of the CMT credential.  It is a very common practice with a new credential to “grandfather” members rather than testing them.  Now keep in mind, this is not a credential that was just handed out to anyone interested; there was a specific procedure involved.  You had to have at least 5 years of acute care experience and a minimum of 3 letters of reference documenting that you not only had the experience, but that you also had  an excellent MT skill set.  To maintain the CMT credential, you have to have 30 credits of continuing education every 3 years.  I earned my very first credit on July 17, 1982. 

I was so excited and felt so proud when I received my CMT certificate!  Now you would think the supervisor and director of the medical records department would also feel excited and supportive, but nothing could have been further from the truth.  The few of us in the department who obtained our CMT were not only not allowed to have that on our name tags, we were also not allowed to even discuss anything related to AAMT during working hours.  They were convinced this new-fangled AAMT was going to lead to unions and demands for more pay.  So for a few years, we just attended our monthly meetings and enjoyed meeting MTs from around the area.  Eventually I met MTs from all over Ohio, some of whom are still my good friends today. 

A few years into having my CMT, our department moved to new offices.  The MTs actually had their own subdivision within the department where we would be away from the noise of the other office workers answering phones, dealing with the physicians, filing and such.  We also had a new director.  I asked her if I could bring in my certificate to display at my desk, with the reply of absolutely nothing allowed to be hung on the walls to damage them.  One of the office workers told me I could use 2-sided tape that would not harm the wall in any way. Now I will say I probably should have discussed that with the director before I took it upon myself to hang my certificate, but I truly felt she would be okay with it, since there would be no damage whatsoever to the wall.  She walked into our office, and in no uncertain terms, told me off right there in front of everyone.  I calmly told her, and with a smile no less because I just knew everything would be okay, that the perfect solution was the 2-sided tape.  I thought her head was going to explode, her face was so red!  I asked if I could at least keep my certificate on my desk, which she did agree to, but she was definitely not happy about it.  I think she could not think of a valid reason to tell me no.

That certificate sat on my desk until the last day I worked there. It was not about flaunting the fact I was a CMT.  I never once have looked at this as a statement that I am better than any MT not certified.  In fact, I have known many over the years who are absolutely the best at their jobs without ever having sat through a lecture or cared a lick about continuing education.  Certification is not about being better than someone else.  If that were the case, then why are there incompetent doctors, bad lawyers, inept accountants, all of whom have credentials after their names. It has always been my feeling that this is about elevating the profession, not elevating me.  If the majority of MTs became an RMT or CMT, imagine the kind of message that would send to the medical community!  It is not a requirement that coders be certified, yet it is rare you see an ad for a coder without it stating certification is required. 

So displaying my certificate was never about saying I’m better than the other MTs.  It was about letting the other health care professionals in that hospital know that my profession is just as important as their’s.  CMT and RMT should stand up there right along MD, RN, RHIT, CCS and every other medical credential.  If we don’t take our profession seriously, why should anyone else?  Next time: Why I decided it was time to make a move in a new direction. 

All in a Day's Work

Many MTs have their favorites, such as a favorite specialty or report type, and even a favorite dictator.  Then you have your not-so-favorites.  I know a lot of MTs absolutely love operative reports, probably because they can be pretty repetitious, so you can get a lot of them done in a day, and production is what it’s all about in our profession, unfortunately, but that’s another story, and you will hear about that later.  They are not my cup of coffee (sorry, I’m not a tea drinker). Taking a look at dictators, well, I won’t name names, even though some of them have either retired or perhaps even passed on, but I have had some real—well, there is no adjective that would suffice. Let’s just say they were difficult, and that’s being kind. 

Back in the old days, MTs actually got to work in the hospital in the medical records department.  So you had access to the patient’s chart, and you had access to the physicians because they dictated in the same department. I think that type of work environment is pretty rare these days.  But to tell you how bad this one doc was, one day I was transcribing one of his op reports, and there was this sentence that none of us could make out.  He was foreign, but his accent was not the problem.  The problem was that he would not open his mouth when he spoke!  Plus I think he liked to chew on cotton, lots of cotton.

He just happened to come into the office when I was sweating over that dictation.  So I called him over and asked him to take a listen.  He got on his knees beside my chair, and yes it is true you can hear better on your knees, he listened, he listened again, he looked at me and said “I have no idea, but you can fix it.”  My fix was to leave the sentence out, with his permission, of course.  Thankfully, his discharge summaries were very, very short, but they were still very, very hard to get through.  I often wonder what it must have been like at his dinner table. 

As you can see, I did survive that first day, but just barely.  I was told that our required production was approximately 20 to 30 reports a day. There was no line counting in those days, and the 65-character line was yet to be determined.  I knew I would not be expected to do 20 reports right away, but I still thought I would be able to reach half that amount.  I was assigned discharge summaries because it was felt those were the easiest.  Our department only did those and the op reports.  H&Ps (history and physical) were sent out to a local service.  I did 2 discharge summaries in the morning and 2 discharge summaries after lunch.  I went home in tears knowing full well I would be told the next day to pack up my desk, and I did not even have anything to pack up!  My husband could not have been more supportive and assured me they would not give up on me quite that soon. 

Sure enough, the next day they did not tell me to leave.  I did decide the only way I was going to learn was to ask.  There were no MT schools back in the late 1970s.  On-the-job training was the only option.  I don’t remember how long it took me to reach that 20th report, but I do remember that I spent the next 2 years asking, asking, and more asking.  I was so blessed to have a wonderful and patient mentor who never made me feel like I was a bother.  The questions became fewer and fewer over that time, and my confidence grew day by day. It would have never happened without the help of Betty.  She did not get into medical transcription until her 50s, and she worked until her 80s.  She loved it that much and never felt the desire to retire until then.   I don’t think I’m going to go quite that long, but I can tell you that I still love it after all these years and that dreadful first day doing acute care transcription.  I will end today by saying that discharge summaries are still my favorite report type.  Maybe because I spent 2 solid years doing nothing else, but I love the variety and that one might be 2 short paragraphs and the next one will be 2 long pages—you never know what you are going to get. 

I eventually did move on to those op reports and even did a little pathology from time to time when that department got behind.  As I mentioned previously, I worked at the hospital for 11 years, and much did happen beyond just getting proficient at discharge summaries and op reports.  I actually got in trouble for becoming a certified medical transcriptionist.  Okay, not because I became a CMT, but I did get in trouble related to it, and I’ll explain along with what I learned from that fun experience, but not today. I hope you will stay tuned!