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Great tips! Thanks for bringing up the

Posted By: subject. on 2007-02-01
In Reply to: When your hands feel like they are - curious mind...




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Great tips!
Thanxxxx...
Such great tips!
Glad I was ''just passing by'' and saw this thread! Such helpful tips for staying focused. Thanks to all.
MS Word 2007 -- I have to switch over to this. Any hints, tips & tricks would be great. Thanks!
I've heard some people are not very happy with it.  Any suggestions on how to get started, and any good tips would be greatly appreciated. Thank you for your help and expertise!
bringing to the top
Coding certification


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Posted By: diddles on 2005-12-22
In Reply to: medical coding - looking for work


First I would encourage you that if you are serious about coding, do NOT go to a course that does not allow to test for NATIONAL certification.  There are only 2 organizations in the US that do national certification.  AAPC (the first) and AHIMA.  With AAPC there are numerous companies that offer their course.  The cost runs between $1200 and $1600 for a three month course of 8 hour classes plus your proctored exam and membership to AAPC, or you can do the self-study course for the same money (I chose to be in a classroom setting so I could have questions answered on the spot).  You can opt to take the course for hospital coding CPC-H (which few hospitals will recognize as official) or the doctor/outpatient based course - CPC, which is widely recognized.



I don't know the cost of AHIMA's testing but it is as intense as AAPC's but it is mostly taken by people who either already have AAPC certification or are already working in a medical coding setting.  Both organizations offer apprecentice programs if you are not already in a coding setting until you can clock some coding hours.  I think you need references to enter either program as to your character - remember, if you make a mistake the penalty could be monetory and/or a jail term.



Now, can you get a job and is the money worth it.  Most hospitals want AHIMA's inpatient certification and 1-2 years OTJ experience, unless they are hiring for their outpatient clinics and/or ER (which they will then accept the AAPC's CPC).  Most of these positions pay between $15 and $24/hr plus bennies.



It is very hard to get into the coding industry.  It's just like trying to get into MT without any experience, only harder.  I would network, join both organizations as a member and go religiously to the monthly meetings to network and learn.  Both certifications require a high number of CEU's to be earned each year.  It is easier to get into a physician's office setting as a CPC.  Most of these jobs pay $9 to $18/hr depending on geography, but again you'd have to be very, very good and have good references from certified mentors to help you get a job with no experience.



Most jobs are obtained by word of mouth.  If you are very good, you could skip working in a hospital or doctor's office and become a consultant and/or instructor without any working experience (more $$ for the instructor's certification).  It would be like working as an IC.  You would have to hustle to get clients and build a reputation.  I was lucky and got a job with a hospital in their outpatient clinic side at $19/hr with hospital bennies and had an offer with the people whose course I took to become an instructor and consultant for them even before I got the results from my test score (but I had prior coding experience).  My job was basically consulting, doing audits and giving feedback and education to doctors on how to maximize their reimbursement, how to document charts properly and be available for their coding questions.  I loved the respect I got from the doctors.  It was totally unlike what I get directly from doctors as an MT.  They are eager to learn, listen to what is being taught, are interactive, friendly and recognize that you are there to help them succeed.



If your MTSO is also adding a coding department to their company, that would be an easier way to get into coding as it could be done from home with access to electronic medical records.  There are a number of tools available to coders that help to electronically code and flag potential errors, hopefully your company would pay for all that because it can be quite expensive.



I tried to portray a clear and realistic picture with discouraging you.  It's a lot like going into MT without someone being realistic with you, so the fact that you asked is a good sign.


Thanks for bringing that up.
I cringe when I read this bord. The cruel and crude remarks meant to make another feel small actually sting my eyes when I read them.

Where did this come from? We were oncde librarians who loved medicine. Now, we have management, the noisy and miserable librarians who insist on an opinion on everything and refuse to budge, our immediate supervisor. I would give a million bucks to be able to be a good conversationalist. It appears that gets one farther than anything in this industry.

Younger MTs? The loud MTs are the ones who are MTholics and think just because they have dissected and analyzed every aspect of the typed medical sentence, the fact is more deaths take place in hospitals now than at any other time, due to medical record errors.

This is about patient health, not the QA, editor, whateverrrrrrrrrrrrrrrr, so I say to this industry:

Lighten the fk up. We are human beings and your colleagues. WHY are you being to rude?

Monitors would help but they love it. The rude remarks to a question leave one with a feeling of disappointment and dread, monitors, so uh, do your job.
Bringing up my DQS problem from down below, how many of the MQ MTs that use this..sm

are running it under XP AND have updated to the service pack 2? Tech Support says that's the only thing he can think of as everything else looks fine on my system. And on the converse, how many of you use DQS and DON'T have XP with or w/o service pack 2, or are just using the original XP w/o any upgrades. I don't want to be doing something to my machine that's going to screw it up even more. Thanks for your help. nm


Chickadee,..bringing this to the top

A better alternative to Lap band is the Medifast 5 and 1 plan. You eat 5 of their meals a day and then what they call a Lean and Green that you prepare yourself. I've only just started, but have lost 9 pounds in 4 days. Check out the website... Medifast1.com

Read the info and check out the message boards. I think you'll be pleasantly surprised.

You can spend 17+ thousand dollars for a band and eat 6 small meals a day or spend a couple of hundred dollars a month and eat 6 small meals a day.


Bringing up old documents....
Hi-I have only worked on Extext for a few days and it seems pretty good. I agree with the problem with inserting doctors names though. I am especially interested in finding out how to pull up old documents as I wasn't told about this feature. Can you let me know? Thanks....
I've often wondered about this one myself - thanks for bringing it up! nm

Bringing up hurricane discussion

Just for some other information.  When Hurricane Rita hit in Texas, i.e. Jasper, Beaumont area, these people were not prepared.  They were not prepared because hurricanes do not come in that far inland.  The Jasper area is one of the areas where most hurricane victims evacuate too.  There are people in that area that are still without power including elderly people and children.  Most of the surrounding areas (Pineland, Rosevine, Hemphill) are retirement areas.  These are also low income areas as well.  These people definitely would not have expected the hurricane to effect them in the way that it did, but it did.


 


Also, people in Lufkin and Nacogdoches, Texas were effected from it as well.  Again, a hurricane never has come close to these areas and these areas are also where evacuees come.  During the time we had evacuees from Galveston, Beaumont, Houston, and still the ones we had from Louisiana drained the resources that we did have here (not saying anything negative by this – just a statement).  None of the businesses could get trucks in to deliver gas, food, ice, water, etc.  When we did get gas delivered, the lines were so long that people were waiting 9-10 hours to get gas and of course by the time most got up there, it was gone again.  This went on for several days.  Even the Wal-Mart here and in Nacogdoches was only able to be open a few hours a day and for the first few days after the hurricane because of the amount of extra people in these areas, they finally had to limit the number of people they were allowing in the store at a time.


 


Some of you say, people should be prepared.  I do agree and especially more so if you live in a coastal area.  However, these people affected in the areas I mentioned above do not live on the coast; however, were heavily impacted by this natural disaster.  You are saying these people don't deserver help?!  Well let me tell you this.  When we had a lot of LA evacuees here, FEMA stepped in and for a lot (not all of course) they received $2000.00 for help with housing, another $600.00 for food, and there $400.00 for something else (honestly do not remember what it was).


 


However, my mother and father-in-law who are elderly went 14 days without power, lost everything in the freezer and refrigerator, and they are also raising 2 of their grandchildren (both young teenagers).  They were unable to get FEMA to help with anything. 


 


I guess the point is this.  Before spouting off about who needs to do what or who the government does or does not need to help (or where you tax monies go), you might want to think about the fact that this was a natural disaster and therefore, no one can ever really be prepared for one.  I hope none of you ever have to deal with anything like this.  It is not a pretty site in this area right now.  Clean up is still going on.  There are still trees down on houses and cars.  How would you feel if this were you? 


 


By the way, yes I do feel that my family was very lucky to come through it unscathed; however, some were not so lucky.


 


Just my 2 cents.


Bringing over HIPAA question
Can anyone answer the question: Do you HAVE to remove PHI from reports legally?
Bringing up from below the subject of low carbs, SM
Food Network used to  have a chef named George Stella who lost several hundred pounds by doing the Atkins diet. I'm not sure if  his show is still on, but he does have a cookbook.
Bringing topic over from 2nd page. Someone
higher rate because he/she has the CMT. I say the reality is that 90% or better don't give a toot about the CMT and are going to pay what they want anyway. And, all the RMT is going to do is cause major grief to a lot of hard working MTs, MTs who are barely making it financially. The RMT will cost MONEY along with their requirements. AAMT has caved to offshoring and is doing American MTs no favors. Frankly, I think the only worth an AAMT membership holds is the money you would be paying to put in their pocket. And, for what? To lobby on the Hill in favor of a bill that would ensure that patients’ individually identifiable health information is secure and protected; improving health care quality and reducing medical errors, and developing best practices to support and accelerate efforts to adopt, implement, and effectively use interoperable health information technology when all the while AAMT is openly embracing offshoring?

In a nutshell, your money is fodder for a worthless organization.

Oh, and Jay and anyone else from AAMT, in case you're reading here, here's a couple of suggestions for AAMTs potential name change...

Foundation for the United Council of Kooks (Formerly Modesto Mavens)
Organization Of Offshore Suckups (OOS)


I agree - can't have any convo w/o bringing..sm

the ones that can not have a discussion about current events without mentioning their fanaticism.....


Most folks have some religion/spirituality.


Most folks don't interject it into every conversation 24/7/365.......just the fanatics!


In my experience when bringing this issue to

my supervisor's attention (when I worked outside the home).  They are afraid to talk to the physicians about dictation - they don't want to bother them.  Makes no sense NOT to bother them!  Now that I work from home, I find that if I leave blanks ---- QA puts in what they THINK is right!  LMAO?  Makes no sense


 



bringing back the work!
In addition to doing MT, I also work as a coder at a very large teaching hospital and academic facility with 160'some clinics. Our transcription is outsourced and recently started going overseas. Guess what - our hospital is bringing it back to the States AND will not accept voice recognition! Too many errors that affect coding, AR days and, thus, reimbursement. Our dictation will continue to be outsourced but will not be allowed to go outside the US and can only be done by a real MT. Too bad it had to be the reimbursement that was the only issue that will bring the work back and not simply the fact that the quality is just not there but..at least there is something that will keep the work here in the US and keep it from being doing by VR. I just thought someone might like to know this is happening. I am hoping other hospitals get the hint.
Bringing up Bo Bice - he is back in hospital. nm
nm
Hey Patti and MQA and other MTSOs..bringing thread to top

Hi again,


Just to let you gals know, I got up the nerve at the last minute, partially because of the posters to my thread about starting my own business, to quickly print up a resume and cover letter along with a sample ortho report and take them to my physical therapy appointment. (They may need an at-home transcriptionist.)  The office manager was not in yesterday, but my PT gave me a little info about how the process works.  Unfortunately, we were interrupted when she was about to tell me what they dictate IN TO, but she mentioned that she thought that was going to change.  On my way out, however, when she was flipping through my chart to see when I should come in next, I asked her if they received the transcription via floppy disk or CD, and she told me, *No, paper.*  Yes, they still use *sticky paper*!  Too bad we got interrupted earlier.  I have a feeling they transmit the dictation via the internet or phone lines, then the Transcriptionist delivers the finished work to the office. 


Anyway, my PT says it is slow right now.  (Indeed, there were only 2 patients in the office at the time with 4 PTs.)  But she thought if things picked up and the sole remaining MT got overwhelmed, there might be a chance of picking up the overflow, which would be just peachy for me. 


More questions...(now, why did I, at first, capitalize the Q in question????)  I may as well start preparing as much as I can now in case I DO snag a job....


1.  Can anyone or everyone recommend a good medical spell checker that interfaces with Word?


2.  What about an Expander to work with Word? I know some use Instant Text, but at least one says she uses the Word Autocorrect feature. (I think.)  Does the Word autocorrect hold a bunch....can you put whole reports into it...large capacity?


3.  You all mentioned that the docs usually supply their letterhead and to use plain copy paper for subsequent pages.  Does the MTSO usually supply the paper or the docs?  Same question with sticky paper...that sounds expensive! 


4.  Any other inexpensive tips you gals can think of that can be gotten ready now besides the main transcriber? (Would want to wait on that to see which type the office uses.) 


Now that I have the ball rolling, I am also going to contact the two MTSOs that I know locally and ask if they have any overflow.  Might also send a sample psych report to my shrink and see if he can spread the word.  Scary stuff, but you gals really helped!  Thanks so much for all the encouragement!!  


When bringing up old documents in Extext, Ctrl S,
I think I missed a step.  I hit ctrl S, put in patient's name (in this case) and then click find, or quick find.  Then, it brings up a list of the patient's admission.  Then, what do I hit to bring up the document?  The options on the right side are statistics and close?  I tried to highlight and double click the admission but nothing.  Need some help here....Thanks
Ooop - meant the RMT- sorry. Txs for bringing to my attn.
xx
OK. Now if your husband is bringing you down by his mental illness and not paying rent
(is husband able to work? how deep is this mental illness? did he have money to pay rent and spent it elsewhere?) then maybe you should think about leaving him rather than placing your kids in any kind of foster care. That has to be traumatic but then so does living on the street. Speaking of placing your children in foster care while you get yourself OK in the head, what is your problem at this point. You see, if there is a lot of arguing and a dysfunctional family living on the streets, then foster care to permanent placement may be better for them. I just don't quite understand how you got into this mess and if these are mental health issues on both your part and your husband's I would look into placing the children. BTW, how old are they?

So all things considered if you don't have any issues other than depression because of a lack of a place to live and your husband's mental health, I would go to a family member or church and BEG for help sorting your life out. If there is more than that going on, including maybe substance abuse along with permanent mental health issues that will keep you from caring for your children, yes I would seek placement for them. And I would seek PERMANENT placement rather than foster care which I would think would be more traumatic for your children.
Bringing the head lice post back up. This has been going around at my daughter's school.
Saturday, after having been checking her head all week, found lice on her head. Did the treatment on her, on me, DH and other daughter, just in case. Only youngest and myself apparently had them. Got rid of the lice, now need to deal with the eggs. No problem with daughter's head because I am meticulous and have been checking daily and removing anything I find. My problem is my own head. Oldest daughter tried to look through, but she had hard time, though she tried. Husband "I don't see anything", so not much help. I can't look at my own head, so my dilema is how do I get the eggs off my own head and keep them from rehatching? Any help/advice would be appreciated. Never gone throught his before.
I was told that Healthscribe outsourced and when acquired, that Spheris would be bringing work
And this is information came to me from the inside, given to me when I was hired and in training.
Bringing up ExpressScribe pedal question again. Does anyone have 9-pin Infinity pedal on a USB?

tia


Thanks for the tips.
By the way, aren't little girls the best?
Thanks for the tips - you were right!
It was great. Cool air, all Ops reports, clear dictators. I realize now the other people on my accounts are getting started at 5:00 am and beating me to all the work. Little did I know!

I only worked for about 2 hours last night because it was a spur of the moment thing and I hadn't napped. I worry about the quality of my work when I'm tired, so I'm going to take a long snooze this afternoon and start work at about 9.

In the 2 hours I worked, I got 390 lines, which is excellent for me with no templates/normals. Woohoo! I'll be able to hit my line count for the day in about half the time it takes me during the day.

Thanks all!
My tips
From someone who goes twice a year. Definetely plan to go Super Bowel Weekend,you will have ZERO wait on rides and just run from ride to ride, it is great. Also the first two weeks in December are okay. The summer and spring break are disgusting, it will put you in such a bad mood after one day. Check out the website Mousesavers.com. They have so much information there about everything Disney. When we go for one night with two kids and Florida resident discount we spend at at $500 for hotel, food, etc, etc. We also get in the Disney mood and think that are made of money so do spend more than needed. I would say go to disney site Disneyworld.com and figure out your ticket prices and hotel and then add $60 for each person per day. That is $20 per meal with a little extra left over from each meal for drinks, snacks, etc. That will be the top amount you need, but it gives you somewhere to start. We try to eat breakfast in hotel, pop tarts, PB&J and then only have to pay for lunch and dinner. Or eat breakfast, skip lunch and eat early dinner. If you need any more tips let me know, I have learned a lot over the years of going.
btw thanks for the tips
You're right, sitting around waiting for the perfect job won't happen.  Something about MT'ing made me feel so comfortable and cozy, now not so much.  I'm in the beginning stages of stepping out and finding another career before the boat sails.  I guess having a few ideas is a start.
Thanks everyone for your tips. I really appreciate all the help!!
Hopefully, I can become an ESL specialist:)
I used to cut the tips off
Where I used to work as they seemed to turn the heat waaaay down at night and on the weekends when there was no one else but me in the bldg. working! I had bought those cheap less than a buck stretchy kind and cut the finger tips off and that worked well for me.
thanks for all the tips !

tips
Do you have one of those old-fashioned grocery stores in your area that still take your groceries out to your car?  Like a Piggly Wiggly for instance?  Do you tip the baggers that take your groceries out?  I seriously had never gave it a thought until a friend of mine went to one of those grocery stores with me and she said that she does.  I've never noticed anyone doing that.  I tip my beautician, at the car wash, and for a manicure/pedicure, but it had honestly never crossed my mind until she said that she did that.  Now everytime I go I'm looking around to see if anyone else does and I still can't figure out if they are or not. 
Tips sm
Wouldn't it be nice if we got a "tip" for every time we saved someone by taking extra time with their dictation? Just a dream, of course! I too give my hairdresser a $20 tip for full highlight, etc., but I find now for just a cut alone to give her $5 is enough as it doesn't take that long. Perhaps I'm cheap, but I think the prices are so riduculous unless you go to SuperCuts, etc., that it's figured into the price. A hairdresser once told me he paid $3.00 for a $45.00 perm solution, of course, no one gets "perms" anymore, but there's a big markup. I try to go according to how long the stylist spends on me, if she gives me extra time and attention, I go higher. Sometimes some of them put on an "act" for you if they're not busy. You have to know the circumstances. My "regular" hairdresser pays for her space, so she has to make her rent and pay a babysitter. I like her, so I'm willing to spend more.
A few other tips, sm
A local noon TV show gave similar tips that have appeared here, but here are a few more:
Keep your money with you, i.e. wear a fanny pack rather than having it in a box or something.
Sometimes people ask to use your bathroom. Don't let them in your house, let them know of a store or gas station nearby with restroom facilities.
If it is a hot day and you have access to a child who is old enough, have them sell ice-cold lemonade. People will buy. Or, just keep a pitcher of ice cold water and paper cups, just to help them cool off.
Set a time and cut prices in half the last couple of hours on the second day, if you really want to sell your stuff.
If you don't want to move the unsold stuff back into the house, consider donating it to Good Will, Salvation Army, etc. Just pack it in your car and drive it over.

Have fun!
Thanks for those tips. (sm)
Those are really some great ideas.

My youngest has 2 more years until he is off to Kindergarten. As much as I hate to wish away the years where my kids are concerned, I know that things will be much easier for me when I have a "full" day to be able to devote to work with no interruptions. Then I will just have to worry about family and friends interruptions, which should be easier to handle!

I did sit down with my daughter yesterday and told her that I was desperate for some help this summer, oferring a small raise in her weekly allowance if she would give me a hand with the boys. She has been spending her days running around way too much. She agreed, so we will see how that goes.

It definitely is not easy to work at home when you have children. I can't even count the number of times I have thought to myself that I need to start looking for an in-house job. Then I remind myself of the benefits of being home for my kids. I think they do outweight the disadvantages in the long run.
Thank you everyone for your tips!
x
Any tips

I am looking to get back into the field after a 12 year break to raise my kids.  Any advice on how to get my foot in the door or who might hire me?  I have over 10 years experience in out-patient radiology.


Thanks.


Thanks for the tips!
nm
My tips here...
"With my tapes, I could type the entire day's dictation for the day in one word document."

Why can't you do that now? I type all my files in one Word document, them chop them up into separate files when done proofreading.

"It takes much longer to download the file, create the new documents, save, and upload than it does to type it."

Well, how long did it take you to get in the car and drive to get your tapes and return them?

I'm not sure what your problem is. I can tell you how I do it....maybe that will help.

I download all my digital files at once, then start transcribing them all in one Word document.

If you can't download them all at once, download the first one and transcribe it while you're downloading the second one, etc.




Thanks for tips
Thank you for the tips.

I just recenty started to use the Expander more for the basic parts of the sentence. It seems as time goes on, more things occur to me. I will check out the links posted too (thanks!).

I need to come up with a good system for labs. I can see that is slowing me down ... and vitals. I am very slow on the number row.

Anyway, I appreciate the ideas posted and will welcome any others that you all might think of.

Here are a few tips (sm)
Have your own "word list" (I use Lil Red Notebook) so once you look up a word and verify it, it will be faster to find it next time.

Also get a good Expander and learn how to use it, not just for individual words but for whole phrases (and even paragraphs) depending on what kind of work you are doing.

Stedman's medical spellchecker.

Try to just work during work hours, and surf only when you are not supposed to be working. This is the hardest thing for me! Sometimes even when looking things up online I get distracted, following links and reading things I don't really need to read when I've already found my answer.

Good luck to you. I have heard nothing but good things about an M-Tec education!
Thank you for all your tips
I am going to look into everyone's suggestions.  I take it IT means Instant Text?  How do you separate your dictionaries with doctors?
VR tips

I work on Edit Script and the average pay for most companies seems to be .04 cpl.  I get .0425.  Your production really depends on the account you have, the dicator and you learining the shortcut keys.  I still have a hard time not using the mouse!  But on the other hand, I am not a stong typist, so I prefer VR over typing.  If I had to do straight typing I probably would not make it in this business, so VR is the way for me.  I had to switch companies because my first one had difficult dictators and I was not making much money.  Things are better now, but still a work in progress.  One suggestion I will make is that you use the Escription forum for productivity tips and also there is a link that will tell you of your progress if you log into it.  The system can read your skills as you use it and give you a report on your progress.  It will tell you if you are using the mouse too much, etc.  It really is a great system with a lot of great tools for MTs.


Hang in there---Sue


Tips for you ... sm
I travel quite a bit with this work. Here's my suggestions:

1. Great laptop
2. AT&T Wireless Internet card
3. AVG security package
4. Bank account with a large national bank .. NO DEBIT CARDS. Use credit card for everything then pay as soon as it appears on your online statement. NO interest is paid. If you pay with a debit card, you have no consumer protection plus your funds could be wiped out. With a credit card, you have a barrier, can dispute the payment, recover lost/stolen funds, get warranties on purchases, etc.

Enjoy.

Tips
Will you please share some tips on what you do to maintain your income level, i.e., the type of Expander you use, how you stay focused, whatever it is that keeps you at the top?  I would very much appreciate it.  Thank you. 
Tips

I definitely would not say I'm at the top.  I get distracted like many with surfing, chatting, etc during my work time.  Honestly, if my work ethic was more strict, I could make another 20-30,000 a year. 


I use IT as my expander.  I am not an Expander queen.  I use them and add all the time but I'm not obsessed with it - but it definitely saves me time and worth every penny 10 fold.  I use my Stedman's Elec Dictionary - another total must have for this job. 


You're going to make more money if you know your specialty and your doctors.  I try to get work where I can do the same doctors regularly.  I would not take a position where there is a huge pool of doctors.  I make the money on my single doctor accounts where I can get regulars and build up speed the fastest.  Even accounts with 4 to 5 doctors you can easily build up speed on. 


Don't settle for cr*p jobs.  As I said earlier, there are better paying companies out there.  Makes me extremely irritated to see companies posting for slave wages wanting so much experience and basically offering nothing in return but the chance to make $5 an hour.  I won't even test until I know what the rate will be.  And honestly, the best companies have the shortest or no test. 


Keystrokes and MDI may look good compared to most bigger companies, but I personally wouldn't work for them.  There are better places, but you have to be willing to do some research and go beyond what everyone else does.   


 


 


tips

I am looking for tips to make my typing faster. For example, auto corrects, quick cut and pastes, etc. Any ideas?


VR Tips

Okay, since so many of us are being transitioned into VR, I thought it might be helpful to start a thread discussing helpful tips on how to be more productive with VR. 


For some dictators (the ones that have the "good" VR come through), I have found that reading through the report and changing it to go more with accounts specifics gets me through it faster than trying to change while listening. 


I also like to use ctrl + lft arrow key to skip by words instead of by letters. 


Other than that . . . I really suck at VR, which is why I am hoping to see if anyone has tips or suggestions on how to help make all MTs more productive on VR. 


TIA.


Saw him on CMT show with John Fogarty. Great, great singer with a neat personality and drop dead
gorgeous without seeming to know it. 
Some thoughts and tips...SM
Your question: If we have
the same tools available to us, why is there such a disparity among earnings?

There is no "secret" or "magic" trick. Everyone is different and has their own skills. There are "great," "good," and "adequate" people in every profession. Some people are "naturals."

Here are some of the things that helped me:

I read VERY quickly and can also proofread as I go.

I rarely have to look up a grammar/punctuation question because it's just natural to me. I can't explain it; I just do it.

I can research and find things very quickly because I simply see/find the information faster.

I worked hard to refine my research skills, learning how to create effective searches and how to find the best information. I find 90% of my information on Google in 1 or 2 searches. I don't go around to site after site after site.

I developed a system for my expander that's very natural for me, so I don't have to stop and find what abbreviation I used.

I add everything I can think of into my Shorthand so I almost NEVER have to look things up twice. I add phrases, names, addresses, etc. I add drugs so I don't have to check how it's capped.

I created Word macros to handle many tasks for me, from removing prefilled headers to format changes.

I spend long periods of time at the computer so I can focus and hit a rhythm instead of doing bits here and there.

I keep my mind on my work. I think about what I'm hearing and how it all fits together. That way, I have a good "fund of knowledge" when the dictation is less than clear.

Hints and tips ...
First, please do NOT even use the term FAILURE to identify yourself in anyway. NO ONE doing this job is a failure, period.

You state you do not use any normals or standards because everything MUST be typed from scratch. Is that "must" coming from your employer or because you don't see a way to do it with the changes you have to make?

I don't often have to use a long "normal" or "standard" such as an entire exam or review of systems, etc. I use word expanders, autocorrect, shorthand, etc., for individual words and phrases more than anything. Nest them. Examples of individual words: Use "ow" for "otherwise"; use "ht" for hematocrit; use "hps" for hepatosplenomegaly. When making your shortcuts, make sure you use what comes naturally. Then do phrases: "hpm" for "0.5% Marcaine" while "hpmx" is "half-percent Marcaine"; use "mzb" for "Metzenbaum scissors", etc.

My most productive times are when I am NOT using a large cut of canned text but literally 'skipping along' shortcutting phrases as they are dictated.

Operative note example: For the phrase "The patient was taken to the operating room and placed on the operating room table in the supine position." -- I have this in 3 separate shortcuts and type:
tptor and poort isup

The only "word" I typed was 'and'...the rest of that sentence was in shortcuts.

Don't jump in there and do them all at once. Try to do 5 to 10 (I would not recommend doing more than 10 a day) shortcuts a day. Write them down in a list and keep by your monitor until you can use them without referring to your list. Then do another 5 to 10 shortcuts.

I'm not boosting my line count in any fashion whatsoever. My accounts are verbatim accounts. If I had long spills of canned text, I'd spend all day editing that to fit verbatim. Instead, I use individual word and phrase shortcuts. The key is to name them so it comes naturally to you.

I do all my medications by starting the shortcut with a "k" because it is so unused and I can easily look at all the med shortcuts in the list. The meds I use most are vancomycin, gentamicin, Tylenol, and ibuprofen. For me, those are listed as kv, kgg, kt, and ki.

Use your autocorrect to capitalize acronyms. I type copd in lower case and have that entered into autocorrect so it automatically capitalizes it for me as COPD -- saves me the "struggle" of having to capitalize it. Then I add an "x" to the end to expand it out, so copdx is chronic obstructive pulmonary disease. Sometimes, if it is more natural, I double the last letter of the shortcut name for expanding it such as gbb for gallbladder.

Shortcut some of your punctuation, too: Using "ft," is "Following this," for the beginning of some sentences.

Design macros to carry out functions for yourself. I hate it when doctors number the first of a list and then there is never a 2nd item. Therefore, I NEVER number the first item even if it is dictated. Instead, I built a macro so that IF he goes on with "#2..." then I hit my macro and it goes back to the beginning of that line, numbers it, and returns to the end of the line, returns, and numbers for the 2nd item. I have a macro that goes back and changes the capitalized heading of "DIAGNOSIS" to "DIAGNOSES" for when there are more than 1 diagnoses listed.

Learn to use your search/replace features, etc.

???? Will any of this help ????