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Serving Over 20,000 US Medical Transcriptionists

I read a local newspaper article about sm

Posted By: . on 2009-06-06
In Reply to: I need suggestions to make money - Please! - Backwards typist

a high school girl started making money at home by converting VCR to DVD. Her grandmother wanted to convert some family stuff, she found out what equipment needed, bought it for grand daughter and off she went. Posted ads on various websites and wants to go full time. Shoot I even thinking. Just have not googled yet to find out what equip. needed/costs etc.


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not sure this will exactly help you, but there was an article in my local newspaper this a.m. sm
that was stating a local doc got in trouble by the board and in part of his requirements it was required for him to use a transcription/dictation service. part of what he got in trouble for was failure to have an H&P on file and proper documentation. it states - for one patient dr. so and so failed to document basic information, including an H&P and treated the patient with excess of 50 narcotic pain medication injections for headaches. yeah, way to go boards!!!!! i'm gonna contact them and see if they need my services, LOL!
Newspaper article
The Sunday paper in my area had an article on headphones and the 3 that were compared were Bose,Sennheiser, and Clear Harmony. They basically said that Sennheiser has the best quality of sound and blocks noise the best. They are all very expensive but if you go online to E-Bay there are new ones listed that are about half-price. I have been looking at the Sennheiser, but like you, I have a very small head. The ones I use now I bought at Radio Shack. They also have very competitive headphones. Good luck.
local newspaper
I just sent an article to my local newspaper asking them to use some of the things from this posting to hopefully make people aware of their personal info possibly being sent to India.  It may be a small step, but like Lillybelle said, if we could get this started, maybe we can make a change.
I read in the newspaper that an online betting site had to shut down...
because there were many very large bets on Danielle winning. Supposedly people were tipped off that she won.

I agree that she shouldn't win. Go Terry!
There was an article in our local paper today about

outsourcing (their wording) work to India.  The contractors in India are now outsourcing the work to other places in India.  They figure if  we (the US) can outsource American work to India, why can't they outsource the work also.   Your medical info is going to be as private as if you took out a billboard and posted it there. 


Article about Spheris in the local paper yesterday...
http://tennessean.com/apps/pbcs.dll/article?AID=/20051125/BUSINESS01/511250360/1003/ARCHIVES
I just read this article...
Wow...those people are downright scary! I don't understand their beliefs at all...a sign in a picture with this article says "God is your enemy"...thought they were all about God? Confusing yes, but they are still scary!
Anyone else read the article
about India having a shortage of skilled workers and how they are worrying about having to pay them higher wages due to the shortage?  Anyone else also find that they had a big old smile on their face after reading the article? 
did you read the article
..
Read this article
http://snurl.com/g7gvc

10-15 cents a line?? I cannot get over that for overseas work. I already make in that range and how many who have have been very experienced and left the profession would have loved to make even 10 cents a line? I strongly urge people to send something about this to the opinion section or even to the writer of this article about potentially their experience, bad or good. This article just blows my mind.
Read this article
http://snurl.com/g7gvc

10-15 cents a line?? I cannot get over that for overseas work. I already make in that range and how many who have have been very experienced and left the profession would have loved to make even 10 cents a line? I strongly urge people to send something about this to the opinion section or even to the writer of this article about potentially their experience, bad or good. This article just blows my mind.
A good article to read...
x
IF you read the article you will notice is

says it is being tested later this year, will affect new customers only, and the test area is extremely limited.  I saw the same thing today about Comcast.


If they do go this route it will be months to years before it affects most people. 


 


I just read the article and was going to post but you beat me to it.....

just read article today that it's become bad site.

Umm, no the OP, but I read the article and it looks pretty legit.
I don't listen to country music, but even if I did, I'd probably boycott the guy.  A living thing shouldn't be tortured whether it's tame or wild.
I read the article and shook my head. sm
I have to agree with you....most of that article was out of our scope of responsibility as an efficient MT. I do not have a MD degree. Who am I to question things like that?

Now, I do agree flagging a report for a blatent error in a report, but that article was over the top for me.

Honestly, my feeling after reading that was this MT or author needs to feel important for some reason, maybe a doctor wanna-be? Since reading that, I have come to the conclusion that magazine is worthless.

in fact - read inside -news article
"There's a critical shortage of qualified labor," said Lea Sims, a spokeswoman for the American Association of Medical Transcription, in Modesto, Calif.

Medical transcriptionists in the United States are aging. The median age for workers in the profession is between 48 and 50 years of age and younger workers are not lining up to enter the profession, which requires extensive training and time to become proficient, Sims said.

Sims, who ran her own transcription services firm for eight years, said she always had more work than qualified people to do it.

That's why the industry has looked at offshore labor, although that strategy comes with its own host of challenges, such as ensuring the security of patient data and encountering communication barriers, health experts say."


AND THIS PART"

CBay's growth in its six years has earned it a spot on private company rankings by Forbes magazine and Deloitte & Touche LLP. The company recently doubled its office space in Annapolis, to 20,000 square feet.

Managers credit the company's growth to its ability to slash transcription costs for cash-strapped hospitals like the University of Michigan Health System and physician practices by relying on cheaper resources overseas. "

Another hospital that sees the need to outsource to India is Mount Sinai Hospital in NYC.



Interesting article I just read about 10 jobs you can do at home. (sm)

So we're considered a thing of the past, ah-hem!  Here are the 10 jobs. ~


Administrative Assistant
Also known as virtual assistants, home-based administrative assistants use office experience and computer skills as support personnel. Many skills easily transition into this position which offers many part-time and temporary opportunities.

Advertising Sales Agent
It's said that Americans are exposed to more than 3,000 ad messages a day. Advertising sales representatives sell or solicit advertising space in print and online publications, custom-made signs, or TV and radio advertising spots.

Computer Software Engineer
Computer software engineers are projected to be one of the fastest-growing occupations over the 2002-2012 period. Duties include design, development, testing and evaluation of computer software, and continual training is suggested for the quickly evolving industry.

Corporate Event Planner
Employed by a private company rather than a hotel or convention facility, a corporate event planner coordinates staff activities including group meetings, client presentations, special events, conventions and travel.

Copy Editor
Copy editors mostly review and edit a writer's copy for accuracy, content, grammar and style. This is a competitive field; however, the growth of online publications and services is spurring the demand for writers and editors, especially those with Web experience.

Desktop Publisher
Desktop publishers use computer software to format and combine text, images, charts and other visual elements to produce publication-ready material. Duties of this fast-growing profession include writing and editing text, creating graphics, converting photos and drawings into digital images, designing page layouts and developing presentations.

Data Entry Clerk
Like administrative assistants, job prospects should be best for those with expertise in computer software applications. By typing text, entering data into a computer, and performing other clerical duties, these workers ensure companies keep up with information and technology.

Insurance Underwriter
Insurance underwriters serve as the main link between the insurance carrier and the insurance agent. Underwriters analyze insurance applications, calculate the risk of loss from policyholders, decide whether to issue the policy and establish appropriate premium rates.

Market Research Analyst
Market Research Analysts gather data on competitors and analyze prices, sales, and methods of marketing and distribution. They often design surveys, compile and evaluate the data and make recommendations to their client or employer based upon their findings.

Paralegal
While lawyers assume ultimate responsibility for legal work, much of their work is delegated to paralegals. Paralegals not only assist in preparation for closings, hearings, trials, and corporate meetings, they also perform a number of other vital functions including draft contracts, mortgages, separation agreements, trust instruments and may assist in preparing tax returns and planning estates.


I read that article. What a joke! Paid a premium for CMT? Well if you consider 8 cpl plus one cen

I've read quite a few things in the last few issues of Advance that have given me dyspepsia and even some reflux from time to time complete with a bad taste in my mouth beginning with their article on "globalization of the medical transcription team" which is just a PC way of saying offshoring of American MT jobs.


Listen, I'm all for a system of checks and balances in medical transcription and I am all for credentialling as a way of maintaining quality control in our industry.  Herein lies the rub, if we mandate credentialling, then the MTSOs have to pony up the dough!  Credentials will need to be recognized with more than just a cent more per line.  We need to be on the same playing field as the HIM employee with their RHIT or the CCS credentials. 


But will the MTSOs be willing to do that?  Not when they can pay an Indian MT a fraction of what they pay an American MT.  So if they start mandating credentials, then there should be a mandate on the MTSOs not allowing offshoring.  When everyone is prepared to do that, then they can force me to get my CMT.  Until then, I'm happy being alphabet free!


dang, that is the wordiest article I've ever read. nm
nm
Has anyone asked their eye doc about heavy computer use causing glaucoma. I read that article on
that. I plan to ask my ophth next month about that.
I probably read about it on MSN or someone mentioned it to me. Maybe call local college or JUCO
?
Just gottah share. I read in our local paper about a 3 y.o.battling neuroblastoma sm

a deadly form of cancer. She has undergone 5 chemo treatments and undergoing major surgery on Friday to remove a lemon-sized tumor on her kidney. This story broke my heart. In the article it read that she will undergo 2 stem cell transplants costing 300,000 to 500,000 a piece and her family needs help.  They do have insurance, but they will be stuck with whatever insurance does not cover.


So, I forwarded the article to everyone on my email list (plent of them) along with a note stating that if everyone in the city and surrounding city in which we live just gives 25.00 to 50.00 (those who CAN give, not those who simply can't), then we could take care of this precious girl and family!  It's times like this when you see the true nature and heart of a person. I have a sister in law whom 3 years ago wrote me this NASTY email after I sent her and many others a email stating that our soldiers were looking for certain items during the start of the Iraq war.  She told me NOT to bother her with such nonsense.  How cruel can one be? Anyways, I did not send her this article and I won't let idiots intimidate me when all I want to do is help this poor girl!!


I even went so far as to contacging a local web hosting company asking them for a free website for this little girl so that those all across the country can give to this family. And I also thought it would be a great way for the family to share with family and friends across the globe on Chloe's progress and updates!  We'll see.


 


I am going to contact the familyl (after praying about it) and ask if they mind me doing such a thing! I don't think she has a website....
The story broke my heart and I just feel compelled to DO SOMETHING.  I have 3 precious children.  The thought of any one of them dying from cancer is too much to even bear!   I will keep you updated on what the web hoster(s) say about me wanting them to provide a free Chloe website! Cross your fingers and pray for her too.


Newspaper ad

RADIOLOGY TRANSCRIPTION
FT M-F/WE


This is the way the ad is listed. The FT M-F job was my job. The weekend job was the one the other Transcriptionist left in December (she graduated from nursing school).


This is copied directly from their ad in the nearest "major metropolitan newspaper".


It's mean of me, but imaging how much work the three remaining MTs must be trying to handle does give me a little bit of comfort. They wanted the office to themselves - well, by golly, they got it!


from canadian newspaper
I am sorry, I can't provide the link but it is a direct quote from a Canadian publication.

"Because the health care plan is regulated by the government, bureaucracy shows it's ugly head. Waiting lists are long and wait times for certain procedures are equally long. For instance, in New Brunswick, a person requiring heart a bypass procedure may wait for up to six months. A knee replacement in Ontario takes about the same. These waiting times are expected and those in need should prompt their doctors to be proactive in diagnosing the problems and gaining access to the waiting list at the earliest possible instance."

Okay, wanna wait six months for your CABG? You'd be dead. I do see that as a problem, don't you. I am sure there are Canadians who love it, just as I am certain there are those who don't. I would like to know where you got that 5% statistic from, though. I don't mean that as a smart aleck remark. I really would like to know if that is the case. Can you point me in a direction that would verify that?
Buy local. The local stores pay taxes to support your city and state. (SM)
Using online and catalogues does nothing to promote the local economy.  We complain about outsourcing and about the big companies gobbling up all the work so the jobs at local hospitals are gone, yet we do the same thing when we buy on ebay, catalog, and these web sites that may be located any place in the world as their primary business location. 
couldn't find an English newspaper...sm
and was newly preggers......I ran around Marseille looking for the International Tribune which was an English newspaper (still is) and then did a scrapbook in tribute to John and I still have that. 
They are still advertising the jobs on their website and in the newspaper

Quite a waste of money if they're downsizing. Oh, and did I mention - they just opened up a new clinic, which increased the work load by about one-third, and now they are building a second hospital? 


Nope. Not downsizing.


Maybe searching internet and newspaper archives - sm
for any kind of stories related to identity theft resulting from offshore medical (or other) records is a start. Another angle would be to look for info. from editors on specific instances (Pt. privacy respected, of course!) where offshored or even US bargain-basement transcription came back with errors that could have caused injury or legal action.
GOT A RESPONSE ON THE LETTER TO OBAMA FROM 1 NEWSPAPER - Not Sure What to Do

It is just a small town paper, asking some general questions about outsourcing/offshoring, pay, types of businesses, etc.  I told him I could not tell him what I actually do for a living or name my company.  Can he find that out? 


I also sent the letter to the Washington Post, Fox News, NY Times, Associates Press, 60 Minutes, and USA Today.  I inserted in the letter about uncertain figures that by my calculation, the number of jobs offshored would be more or less the equivalent to the total population in 3 states in the U.S. 


What will I do if they find out who I am and who I worked for?  Can I be sued?


I went local. Great local tech support, they know what I do and were able to set it up just for me
:)
It is so easy to post a letter on a newspaper editorial or magazine. Everybody write one.
If you have a story to tell - get busy.  Go to news shows, magazines, newspapers.  It is so easy.  Talk about the MT business or about the whole offshore process and its cost to the U.S.  Any and everything written only solidifies our total point of view.  GO TO whitehouse.com for sure.  Don't wait for others to carry this for you.  Support Travelin MT's efforts on the company board!!!!
In 12 years of MT'ing I've never re-read an entire chart. Edit/read as I type. nm
x
Yes, I read your post, and I just re-read it, and I've copied and pasted for you in case

you've forgotten your own words! Your post above is 100% different "flavor" to it, now all positive and cheery! Your first post was 100% doom and gloom every which way, including "raining on your parade", and "if you want to go forward"...God, sounds like she's talking about jumping into oncoming traffic! Here is your quote:


My first boss (the one who hired me as a new grad) gave me some words of wisdom that I haven't forgotten. She said that transcribing at home with small children NEVER works under any circumstance. Either the work will suffer or the parenting will suffer.


****


How can the word "NEVER" in caps be interpreted in any positive way? You took about 8 paragraphs to cover every aspect and completely dash this poor woman's dream.  I'm not blind, I'm not talking about day care at all, I'm talking about the total negativity of your original post! You know exactly what I'm talking about, cause you added some sugar to your second version! And that's much nicer than the first!


Oh I've read that site and continue to read it...sm
I agree...much motivation there. I have tried to quit numerous times in the past and did successfully quit when I was pregnant for the first time many years ago but I have never managed to summon up the strength or resolve to stay quit. Thus the "need" for a financial investment in my efforts. It somehow makes it more motivational to know that I have $$$ invested in this effort over and above the $$$ saved on cigarettes.
Who had time to read?LOL I only get a chance to read This Old House once in a while. (nm)
x
I didn't read the other posts but just read this
My daughter got pregnant at 17, said she wanted an abortion but BF didn't. I have a wonderful 2-1/2 yo grand daughter that I don't think I could live without...and now, guess what? I don't. I have custody of her. She was dropped off on my door, I got court ordered temporary custody and final custody hearing in a month.

I'm single with no family support. I had just taken a new MT job one month before this happened and they have been wonderful during my adjusting to being a mom again and I hope I can resume a normal schedule by next week.

I'm passing no moral judgments or giving moral advice. The situation is what it is. My prayers are with everyone involved.
Definitely an eye-opening read. Having my teens read it, too. nm
s
article
51, trained on the job 26 years ago,
article...

I'm 57, learned on the job 28 years ago.  I can out transcribe people half my age.  I have no arthritis, no carpal tunnel syndrome, no fibromyalgia and only occasionally get a crick in my neck from my job.   My QA score is 100%, has been for years, and I type 90 wpm, transcribe 200 lph at least and that's on an account that is almost all ESL.   I could do this job another 20 or 30 years if I wanted to (barring sickness or accident that could happen at any age).


As far as the AAMT rep saying younger people are not lining up for this job - have they done anything to market MT to younger people?  I'm sure a lot of high school kids or even community college people would be interested in this work if they were educated about it. 


One last thought - the people they are offshoring this work to in India, Pakistan, Trinidad, the Philippines, are not spring chickens!!! 


I for one am sick of AAMT trying to justify their greediness by blaming their victims, the US MTs.


 


article
There was an article in the news online that said it has spread to 3 more countries through ducks and geese and that it's only a matter of time before someone carries it here.
one article
Boy do you have it wrong, we have both stated our sources about googliNG pet food ingedredients, and if you choose not too, that is your problem, I am sorry for your pets, but you need to read up, not one article but thousands. I hope you check your facts, sincerely,
Article
Can anyone tell me where this article was originally published? I forwarded it to a friend who asked... I wasn't able to tell her.

Thanks!
Article.........sm
http://health-information.advanceweb.com/common/EditorialSearch/AViewer.aspx?AN=HI_06may22_hip18.html&AD=05-22-2006

Try pasting this in your browser - it's an article from the latest Advance magazine called A New Set of Shoes for MTs!

I saw that article too

My first thoughts were like you, just another way to cheat us.  But then when I considered the possibility (trying to be kind here) that some companies are not giving us full credit for every character typed (as in perhaps counting 3 Keystrokes as 1 as has been mentioned here before), then even if they didn't pay us for spaces, we might make more in such a situation if they had to pay us for every single black character.  They can't hide that from us!  In other words, they would not be able to manipulate the line counting as much as I think they are doing now.  Now how much they would pay us for every black character might differ from company to company, but I think this might work in our favor overall.  If pay based on production is better for us than an hourly wage, we need to find what works most to our advantage.   And with the difference there is out there now in line counts from one company to another, pay by character might help us. 


And yes, even if it is a template, every character should still count as well as spaces, returns, tabs, demographic insertion, and also for our knowledge which comes into play every single time we keep the dictators from sounding like idiots and/or catching their mistakes.  Let's face it -- we do at least basic editing too, folks.  We are NOT just typists!  We should be reimbursed for our knowledge as well as production.   We're not donating our time to a charity here.  This is a way of making a living.  We should be paid for whatever we do for the company we work for, just like in any other job.  This might be a step in the right direction. 


I am cautiously almost hopeful. 


 


Here is the article
http://www.networkworld.com/net.worker/news/2002/0408networker.html
I think her article is a little sm
outdated in reference to VR.  Apparently she hasn't been out there in trenches lately.  There is a LOT of VR work out there and unfortunately the pay isn't great, in fact it's awful for the work involved.  Although it won't actually replace the MT, but rather move them into a different area, the pay is never going to match the effort that must go into it. 
FYI - article
I just read an article yesterday in the Oakland Press that Oakland County, Michigan, is getting rid of all their court reporters and going electronic to save money.
EMR Article
I have done transcription for about 19 years. Over the years I have been concerned about off-shoring and voice recognition, but still felt fairly confident about still having work for a long time. Now, with the EMR system coming into play, along with the other factors mentioned above, I feel that eventually, not too far off, this is a losing battle.

I love doing this type of work. It has supported my family while my kids were growing up, I had a secure hospital job, and the luxury of working at home, I have to face reality though.

I am going to go back to school and maybe look into being a radiology tech and/or ultrasound. I will not take anything in medical records, such as coding or biling, as I think that will also become automated eventually, and is already in some instances.

I think doing the editing and/or transcription (if there is any) would be a good part-time second job to have in addition to another job, but not fulltime, as I don't think you could support yourself. I still have a good 15 years or more of working left and do not want to be left out in the cold whle hoping that this is not really going to happen.

I think if the off-shoring could be addressed it would keep more work here in the long-run to keep us working until we have other options. I have seen postings here regarding contacting the president regarding off-shoring transcription (which is a good idea) but you need to also write your local congressman in your particular area. That is what they are there for (that is very important.)

It is ridiculous that the medical records of patients are so highly confidential, but yet we will send it to another country, and with the economy as horribile as it is too.

Maybe the government should retrain us LOL.

I do feel sorry for the newbies, and that these MT schools keep recruiting people into this occupation, and they probably know full well what is going on.

Just my opinion.
EMR article HERE
From Medscape Family Medicine
Physicians Are Talking About...
The Government Push for Electronic Medical Records

Posted 02/24/2009

Nancy R. Terry

The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs). Recent postings on Medscape Physician Connect (MPC), a physicians-only discussion board, offer frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed.

"EMR is the worst thing that has happened to me professionally in over 25 years of practice. My care of patients is impeded and the quality of my care is worse as a direct effect of the introduction of EMR," says a MPC contributor who championed the installation of an EMR system for his physician group.

"I absolutely love our EMR," says a nephrologist. "It has improved the quality of our practice immensely. I spent a lot of time customizing for our practice, but it was worth it. Everything is point and click. To improve care and cost, all patients need a Web-based collection of medical records that include hospitalization, lab reports, x-rays, as well as office notes. That would be the ultimate care."

Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians.

Some of the MPC physicians least satisfied with their EMR systems are those practicing at large healthcare companies or medical centers. "My hospital solicited medical staff support for EMR," says one MPC contributor. "After implementation, administration took over and now EMR is solely for the benefit of medical records as a storage device. To he11 with the medical and nursing staffs. RNs are input clerics rather than beside nurses."

"The very few efficiencies were all on the administrative side," says a regional medical director who helped bring an EMR system to a nationwide healthcare company. "A good sales pitch with nice graphics and testimonials sell it, then the clinical staff is left to suffer."

"EMRs need to address work flows and clinical efficiencies and not seek to provide administrative support," says a general practice physician. "Unfortunately, the administrators are the ones with the time and energy. The rest of us are seeing patients."

In smaller practices, issues of EMR maintenance and support infringe upon patient care. "In my clinic," says a family medicine physician, "provider meetings are completely dominated by EMR issues and problems. There is virtually never time left for discussing topics pertinent to improving patient care."

In speaking about their day-to-day experience with EMRs, primary care physicians complain that entering patient information is cumbersome and time consuming, often because of a template-based system that does not reflect the patient encounter.

"The assumption of the EMR is that you already know the diagnosis when the patient arrives." says an MPC contributor. "This may be better for specialty care, but in primary care, patients come in with fatigue, rash, insomnia, diarrhea, and cough. It's difficult to enter all this until after the visit."

An internist who describes herself as "tech savvy" says that her system's scripted entries for patient information are inadequate. "If you free-text, it is much more time consuming. And we are discouraged from free-texting by our administration because it doesn't trigger adequate billing codes. Not only has it reduced my time with patients, it has added an extra 2 to 3 hours of work each night from home."
The Choice of Systems

"My advice to practitioners," says one MPC contributor, "is wait for a decent EMR that produces useful notes that accurately describe a patient encounter in a way that helps a clinician."

Waiting may not be an option for much longer, however. One provision of the government stimulus plan would impose reduced payments on physicians who are not "meaningfully using" information technology. Whatever is meant by the provision's phrasing, one thing is clear: the push is on to go electronic. Physicians must learn how to make information technology work for them. One EMR expert says that it starts with the choice of systems. "Primary care practices should stay away from templates and stick to a new program by Praxis® [Infor-Med Medical Information Systems, Inc., Woodland Hills, California] that uses pattern recognition of similar cases as well as rare cases. It decreases the workload immensely. For specialty practices, I recommend templates, and Visionary™ Dream EHR [Visionary Medical Systems, Inc., Tampa, Florida] is excellent in being very user friendly," says an MPC contributor whose research in medical management focuses on EMR systems.

Another MPC contributor notes that the technologically adventurous can customize an EMR system by using open-source software. In open-source systems, he explains, the source code needed for programming is included in the software, making the program infinitely adaptable. "When you buy most proprietary software, you have to accept the functions that come with it, as designed by the developers. With open-source systems, you can modify the software to your heart's content."
Is a Choice of Systems Really a Choice?

For some physicians, however, EMR systems remain a nonissue, and the heavy government funding of healthcare information technologies is nothing more than a smokescreen obscuring the real issues in primary care.

"The government and the public are not able to deal with the real problems facing medical practice and the real solutions necessary to turn it around (ie, reasonable reimbursement rates, malpractice reform, regulation of the unscrupulous practices of the insurance industry)," says an otolaryngologist. He adds that once healthcare information technology is "fully implemented and solves nothing, we can start to talk about real reform and real answers."



Author Information
Nancy R. Terry, medical writer and editor, Jackson Heights, New York

Disclosure: Nancy R. Terry, has disclosed no relevant financial relationships.

Medscape Family Medicine. 2009; ©2009 Medscape