Gurgaon, India – Richa Singh and her classmates have sat through a lecture on cardiology, a video on heart disease and a rerun of “E.R.”
Ms. Singh is training for India’s new knowledge economy. She isn’t a medical student; in fact the 27-year-old is already a dentist. Instead, she’s vying for a highly competitive job transcribing dictation from doctors in the U.S., which she believes will offer better career prospects.
India is experiencing a boom in offshore clerical services thanks to rising labor costs in the West, satellite communications and time-zone differences that allow transcriptionists to work while doctors in California sleep. The next morning, they awake to a hard copy of their patients’ records.
Such commercial links helped pave the way for President’s Clinton’s visit to India next week, says Richard Celeste, U.S. ambassador in New Delhi. For America “India was always the blank spot on the other side of the globe. Today, it’s the place where we do the other 12 of hours of our business,” he says.
But because of its huge crop of low-wage, well-educated English speakers, India is leading this global trend. The medical scribe business is more forthcoming. In a drab basement, Shilpi Bajwa dons a headset and begins her eight-hour shift at Selectronic Equipment & Services Ltd. Fresh out of college, the 21 year old Ms. Bajwa earns $150 a month, a comfortable starting salary for India. Top Selectronic scribes earn $350 a month, or $4200 a year, a fraction of what their U.S. counterparts make.
“It’s hard to get a well paid job like this,” says Ms. Bajwa, who joined Selectronic’s 200-strong staff two months ago. A science major, she is surrounded by other university graduates, in literature, computer science and even medicine. Some 400 people had applied with her for 100 slots in the company’s training program.
Because of malpractice concerns, medical scribes can’t afford to make mistakes. So Selectronic’s six month course trained Ms. Bajwa in medical terminology, including anatomy and drug names. Just as important, she was bombarded with all the baffling dialects of American English, from Texan to immigrant Chinese.
Training lectures are peppered with doses of American popular culture. In a Selectronic lecture hall, 47 trainees have their eyes — and ears — glued to an episode of “E.R.”
Selectronic transcribes patient’s records for several U.S. hospitals but won’t disclose their names due to confidentiality agreements. Because it guarantees 98% accuracy , the company requires quality-control officers to review each file before beaming them back to the U.S.
Most physicians dictate into a toll-free number, which is linked to a medical transcription company. The dictation is converted into a voice file by computer software and transferred to India via satellite. At Selectronic, the files are opened by a connecting server and distributed to transcriptionists. Completed texts are sent back via e-mail to the U.S. where they are downloaded and printed out for the doctors to review.
Selectronic is a family-owned startup, but U.S. companies have also entered the field.
Are the transcription companies becoming white-collar sweatshops? “We are getting employment. We are getting well paid,” says Raj Kumar Bali, a Selectronic trainee.
The training itself has become a money-spinner. When Selectronic started, it had to pay job applicants to take the six-month course. As job seekers soared, the company cut back and eventually eliminated the stipend. Today, Selectronic charges about $200 for the course. And there is no guarantee of a job. New technologies, such as voice recognition software, could some day alter the dynamics of the transcription business. Verbatim transcription is useful in some industries, but for legal reasons, physician’s mistakes — technical and grammatical — must be corrected by the transcriptionist.
In the meantime, even the American Association of Medical Transcription welcomes the advent of the industry in India. There are an estimated 250,000 medical scribes in the U.S.; not enough to meet demand, says Claudia Tessier, executive director of the association.
The workload will only rise as nurses, social workers and dieticians seek transcription services. “Everyone has a backlog,” says Marge Parker, president of the Florida Association for Medical Transcriptionists “We can’t keep up.”