Stay Away From Nuance Medical Transcription!

Stay Away From Nuance Medical Transcription!

As you probably already know from previous posts, I am a recent graduate of the Medical Transcription course at Everett Community College here in Washington. I finished up the course in 1 year 3 months since I hit a few speed bumps along the way that prevented me from finishing up in the allotted time of 9 months. Regardless of how long it took, I did it, and that is a huge accomplishment for me.

After graduating, I immediately set out the hunt for jobs who hired beginners in the Medical Language Specialist field, and Nuance happened to be the easiest to get the foot in the door with so to speak. They required me to agree to work full-time for the first year since I was entry level and I needed to have a 99.5% accuracy at all times, but they would be lenient with me to allow me to get up to speed since I am a beginner. Since I would be hired as an employee, I qualified for benefits after 90 days too. Everything sounded good and I started training for the work at home MLS position on February 4th, a few weeks before my Vegas vacation. The training was extensive video watching, probably a little too much to consume, which left me confused about the platform I would be working on. I did have live training a couple times, but they basically went over the same thing that we watched in the video and it helped some, but of course, you’re not going to remember everything that you had gone over previously, especially since they didn’t want me to start until after my vacation. So 2 weeks go by, then I have my vacation and start my official start date on March 6th at noon. I did not have any idea I would be starting that day since my supervisor decided to say just jump right in after our phone meeting. That was fine, but I didn’t get much done because I was trying to familiarize myself with the platform, account specifics that doctors require from you and a bunch of other stuff.

The first week was rough, as to be expected. My supervisor requires a weekly phone meeting to see where I am at. She recognized my errors immediately and told me I needed to improve these. For those that don’t know anything about medical transcription/editing, you’re basically listening to a crappy recording of a doctor who talks like an auctioneer or a foreigner or someone sucking on a cough drop or whatever the case may be, and you need to transcribe exactly verbatim. That means if you miss or add any of these when they are not said, “the, an, a, and, etc.” you will get marked off for it, and believe me, it affects your accuracy rating. I had a lot of them because the recordings for the most part sound so garbled, or doctors wouldn’t enunciate correctly, so even though there was a “the” in there for “the patient”, they would say it so close together that you thought they were only saying, patient. I have even added a the in there to make it “the patient” when there wasn’t because I figured that it was more grammatically correct. Don’t ask me why you get dinged for these nonsensical errors because I don’t have a clue. Now don’t get me wrong, I had a few critical errors for not seeing that the patient’s age was incorrect. You would think that the doctor should be penalized for this since he’s the one that spoke the wrong age, but nope, it’s our ass if it’s wrong because we are the ones that have to fix their reports. Critical errors are the highest errors possible, which is a HIPAA (Health Insurance Portability and Accountability Act ) error. We could be sued for these errors. Now do I think that an incorrect age is going to put the patient’s life in jeopardy? Not really. My errors were not huge errors to where the age was a child, but put as an adult; nothing like that that I can see affecting the patient’s outcome with possible medication and whatnot.

Week 2 went by and I still had errors as to be expected because no one is perfect, not even the men and women who have been doing this for 20+ years.

Week 3, my errors were still there but slowly and surely improving from the previous 2 weeks. My supervisor scheduled a meeting with me and HR, more than likely to scare me into trying to do better since she’s evil like that. On the phone meeting, they made an agreement, not me, “THEY”, that I need to have half the errors of week 3 for the next 2 weeks. This means I have very little leeway, even though I am still new at this. Three and a half weeks is not enough time to be perfect at the platform when you have to pend to hospitals, search patient information to make sure it’s correct, make sure the work-type is correct (which I think should be the doctors responsibility), the correct date of service (again, doctors should input this information before they upload it to us, the client) They’re getting paid to see patient’s for like 20 minutes, yet make you wait in the waiting room, and again in the exam room for hours while they come out and speak their reports for us. You wonder what they’re doing, this is what they’re doing, along with visiting with their peers. You hear so much stuff on the recordings that it’s quite humorous. You may be thinking I am a bitter doctor hater, but I assure you I appreciate everything they do for us, I just don’t like how they get ridiculous amounts of money when we’re the ones doing their paperwork for pennies. This job position used to make $20+ an hour, but ever since outsourcing became the norm, they make everyone work for pennies or in my case $9.19 an hour which is the minimum wage in my state. (if I wasn’t an actual employee, I would have only been making $5.40 an hour which is ridiculous.) This is a lot more than some places, so I was grateful for that, but for the amount of work you do, it’s a complete joke. So, half the errors for the next 2 weeks did not seem possible to me. Not to be negative, but I knew that goal was way out of reach with this being my first MLS job.

Week 4 was much better. I had half the errors as the previous weeks, but my supervisor didn’t care because I already failed her 2-week requirement. Our phone meeting consisted of her being quite angry about FIESA not working correctly so she could check QC’s grades for me. I mentioned that one QC person, in particular, kept dinging me for the same thing over and over and there were about 10 in that report. She immediately fixed those once she saw them, but that still didn’t give me any leeway for the job as she said it’s up to HR if I get to stick around or not, which was a new phone meeting scheduled for next week.

Week 5, I am doing markedly better and had half the errors of week 4. My accuracy was even 98.6%. But, since I failed their goal, it didn’t matter. They didn’t see me as improving up to their speeds or standards. I was improving slowly but surely each week and they didn’t give me a chance. My supervisor complained to HR, otherwise, none of this would have taken place because they’re all scatterbrained for the most part anyways. Most people don’t even clock in on days they’re supposed to and HR/payroll doesn’t care. So basically this goes to show that my words stand correct.

HR was on the conference call and told me sorry, they had to let me go because my errors were consistent. My supervisor was lying to her saying I had more errors than what FIESA was stating, but I wasn’t going to sit there and argue with them because I want a company who is actually willing to work with their employees and give them all the possible help they need in order to succeed.

Had I known that this job would not be a place that I could learn to grow, I probably wouldn’t have wasted my time. Hell, I wasn’t even given a 90 day probation period to get up to speed; whereas if I was given one, I feel like I would have been way more familiar with everything and could have improved drastically.

…you live and you learn I guess.

For anyone trying to do Medical Transcription as a career, I honestly hope reading this makes you avoid it like the plague. Each company outsources to other countries because they work for less. Big dogs are being let go because they make too much money, and they over hire new graduates because they know they probably won’t last long enough to make it anyways. So let this be a warning to you. I wished I had someone telling me that this was a dying field before I went to school for it. BTW, if you’re currently in school, don’t bother listening to them say that you SHOULD or NEED to get certified or registered. This is just a ploy to give money to AHDI, the people who started the certification process. No MT job asks for it or makes it a requirement according to numerous people on the MTStars forum board, so don’t waste your hundreds of dollars testing for it!

Hospitals are letting go of their MLS workers and being bought out by bigwig companies like Nuance and M*Modal. Just know, that if you do decide to work for any of these companies, you will not be able to financially support yourself on your own. If you’re a supplemental income and you don’t mind working for minimum wage, then go for it. You might have better luck than I since there are millions of different accounts to work on and different supervisors to work for!

I just wish you good luck, because you’re going to need it.




  1. / 6:40 PM

    This is ridiculous! Sorry you went through all that! Sounds like a really bad company. I hope people are reading this that are thinking of working for them!

  2. / 3:48 PM

    You’d make more on Fiverr! I make bank there proofing!

  3. / 3:59 PM

    It definitely is Jody, thanks for the kind comment and I do hope people read this and attempt to avoid Nuance.

  4. / 3:59 PM

    It definitely is Jody, thanks for the kind comment and I do hope people read this and attempt to avoid Nuance MT.

  5. / 4:00 PM

    Really? I had never thought of looking into Fiverr for this kind of thing. Thanks for the tip!

  6. / 11:33 AM

    Is that per line or? And I agree, these companies should be ashamed of themselves!

  7. / 11:02 PM

    Are you still trying to work as a transcriptionist? I’ve recently come across a company that will give new MTs a chance and seems to have an encouraging system to enable MTs to become successful. I do not know much about them, however, but their website looks promising. In case you are still interested in transcribing, you might want to check them out:

    You’re post above is spot on, though! Nuance is probably the worst of the worst, but breaking into transcription is definitely tough no matter where a person works. There’s a giant learning curve after schooling has completed, and it’s ridiculous that a company would hire a new grad and not mentor that person for a considerable period of time!

    Good luck in whatever you decide to do!

  8. / 7:09 AM

    Yes I am still trying to find a spot I believe I’ll succeed at with transcription. I decided to give entrada a try, but you have to intern for them before they will hire you. So that’s what I’ve been doing the past few weeks. I guess I could always apply elsewhere in the mean time!

    So far with Entrada (if anyone is curious enough to try and work for them) they pay the normal editing rate that most companies pay you, but their voice to text software is no where near as comparable to Nuance’s. I am pretty much having to retype the entire reports at an editing rate. So that stinks! But, entrada’s software and whole process is more user friendly and that’s what I like about them.

  9. Scribeyou lmt
    / 12:18 AM

    This are really nice blog about Medical Transcription i am also a trainee medical transcriptionist thanks for your valuable suggestions.

  10. DanaG.
    / 1:04 AM

    Thank you so much for your opinion. I was feeling bad that Nuance had put me on their wait list so to speak. Most of these companies are pushing ESL hard. I’m on the back burner of 4 companies right now simply because I was excellent on the practicum sections except for the 1 dictation where it was clear American English, I had too many blanks for them, was not that doctors first language. I’m really wishing I went to one of those schools for nursing and took MT later as just something to put under my belt because in a national disaster Nurses and medical assistants are going to be the one’s forced to transcribe dictation. I just can’t see extra money getting kicked out to pay MT’s during a crisis. I’m hitting up general transcription companies just for work while I practice listening to ESL and transcribing it as perfect as possible before I start testing with medical transcription companies again.

  11. Jacki
    / 4:10 PM

    I never had any of these issues. I left because I found a local hospital to work for. The current company I work for I made over $36,000 last year, and that is great if you consider I don’t have to leave the house. I love my job as an MT. I would never change a thing.

    • Jenny
      / 8:45 AM

      Well, consider yourself lucky. Finding a hospital job that isn’t being bought out by Nuance or any of the other big MT companies is like finding a needle in a hay stack. That’s awesome though for working from home!

    • Gail
      / 4:10 PM

      Where do you work? Are they hiring?

  12. / 11:48 PM

    I’m so sorry to hear of your experience. You’re absolutely correct: medical transcription is a dying field, one that is being replaced by automation and outsourcing. Nobody cares about accuracy, and Nuance is the worst. They bargain to win hospital accounts, promise to hire the displaced workers, even pay their current wage for a month or two, then the real fun begins. Making pennies per line to edit voice recognition and having to retype the entire report for those same pennies is the norm, not even making minimum wage. And Nuance outsources to India, only the hospitals don’t realize it or don’t care. I’ve been transcribing for nearly 20 years and saddened to see what was once a well-respected and honorable field being chipped away to nothing.

    • Jenny
      / 8:46 AM

      That’s one thing that makes me extremely uncomfortable about all of this outsourcing. They have access to our personal information. Something that they SHOULD NOT!

      Thank you for your comment.

  13. Jan
    / 6:06 AM

    i only wish I had read the scores of reviews about how awful Nuance is before I signed on. Whatever you have read, it is 10 times worse. You are NEVER going to get it right. Just do not take the bait. They promise you the world. It is a huge waste of time.

  14. JJ
    / 1:14 PM

    I agree with you.

  15. jennifer
    / 9:31 PM

    We were just told Friday that the hospital I work for is being outsourced in 3 months to Nuance. We were told Nuance will take on 100% of us as their employees and honor our tenure, ect., ect. They promise this and that. You think I’m going to work for them after reading this? Hell no! I’ve been doing medical transcription for 16 years. I make currently 40k a year. This is not right what they are doing. I guess I will look into coding and maybe go back to school. I feel like I’ve been punched in the stomach. I just had twins last year, so now I have two 1 year olds and my husband makes way less than me. We promised ourselves we wouldn’t put them in daycare which is why working from home has really worked out. So now what do I do? Go unemployed? That is a huge hit for a family of four. So sad……

    • Jenny
      / 2:22 PM

      I’m really sorry to hear this. Thanks for sharing your story. Unfortunately this is happening far too often.

    • Cidalia Martins
      / 5:06 AM

      If you haven’t settled into anything yet, consider legal transcription. I’m looking into it, and there are smaller companies that hire nationally or in North America only that are willing to train to fill in any gaps aa long as you have the basic skills (transcription and grammar/punctuation skills). At some point, once I’m very familar with legal and court documents and transcripts, I’m hoping to branch out into transcript proofreading.

      • Jenn
        / 3:13 PM

        That’s the problem I have. You have to have immaculate grammar/punctuation and that I clearly do not have. LOL Thank you for the recommendation.

  16. Mitzi
    / 7:41 AM

    Sweety, I’m sorry you have had problems, but this is the medical transcription world. Welcome. I wonder at the training you received maybe not preparing you for what was to come. It’s a tough job! Not some easy work at home job that a lot of people think it is. You work very hard, get very frustrated and want to scream sometimes, but its a great job. I’ve done this for 14 years now and I work for Nuance. I’ve worked for a few other companied, but honey, what you experienced with Nuance is just the way it is. The jobs you type directly effects that patient’s care. It is extremely important that everything is correct or a patient could suffer from it. That is why supervisors are so adamant that everything is absolutely correct. Think of each patient job you type as one of your own loved ones. Connect with that family mentally and think, think, think, You want them to get the absolute best care possible so you have to make no errors on the reports that nurses and other doctors will be reading to care for that patient.

    Good luck to you.

    • Jenny
      / 2:21 PM

      That’s true, but I WAS NEW, and we all know that reports go through QA before they’re submitted to client, especially those that just got out of school for transcribing/editing. I know that this is a tough field and errors are not ideal but everyone makes them regardless of how long they’ve been doing this. Doesn’t mean I have to accept the way they treat people. Nuance is a crappy company to work with/for.

    • Anon
      / 11:12 PM

      Honey? Sweety? Condescending much?? I work for Nuance, but THANK GOD I have a job interview later today at the local hospital that is ready to more than appreciate my Associate’s degree in Science, which Nuance simply ignored. I have worked for them for the past 6 years, and yet, I have never been offered a promotion, such as POC or transcription lead. I went from making 60K a year working directly for a hospital (mostly editing, very little straight typing) to less than 10K a year….that is QUITE A DIFFERENCE, don’t you think? It’s great that you can cheerlead for Nuance. They need more worker bees like you. You are apparently PERFECT in every way. Can I ask how many accounts you have in your que? I have 8….all with different account specs, different doctors, who may or may not love the sound of their own voice even though they can’t speak English to save their lives. And honeypie, sugarplum, I can tell you RIGHT NOW that dictators are not held to the same standards that we Nuance MTs are held to, and that is why our pay stinks to high heavens and we don’t have a leg to stand on when it comes time to get our butts reams by QA (the end all, be all, grand poopahs) where there is NO CONSISTENCY on how reports are graded. I am not formally trained (gasp….surely not, right?!?!?!?) and yet I was hired and have managed to keep my job. I was attending a 4-year university (started out in Nursing and then had to quit the program to take care of my father while he was dying of cancer, and then went back and started the HIM program), majoring in HIM, and only did medical transcription as an afternoon assignment 1 day, being told that this was only to familiarize me with the goings on of what I would be managing at some point (Haaa haaa!!). Of course, I had medical terminology out the whazoo and almost every science course offered at the university, hence the Associate’s degree in Science (in lieu of my Bachelor’s in Nursing or HIM even though I had to put my degree on hold after my divorce). A person can only do so much with what you are supplied with. Horrible dictation is not acceptable, and I don’t give a rat’s buttocks if the doctors ‘just don’t like to do it so that is the reason why they don’t put any effort into actually speaking clearly.’ Well boo frickin’ hoo….I bet the docs like their paychecks more than I like mine. I could sit here and give NUMEROUS ACCOUNTS of the wrong doings at Nuance, but why bother. As you said, that apparently is just the way it is. And by the way, if I was a patient or the family of a patient, I wouldn’t expect the keeper of the light, which is this crazy occupation of taking garbage and making it sound legit (if allowed by QA’s individual subjective scoring practices and which is actually a legal document once it is signed by the physician or health care provider), to do it just for the sheer pleasure of it. This isn’t Unicef….

      • ex-QA
        / 5:14 PM

        Anon, I thought the same thing about the honey, sweetie stuff! You said it better than I could. I was a QA for Nuance, and believe it or not, the QAs get dinged by Post-production QC “specialists” who are just as arbitrary. I didn’t make my 99.5% for 3 weeks in a row and was put on “probation” (they have a fancy abbreviation for it) Then I was “demoted” to MLS. Then, the new compensation plan was rolled out, and as an MLS, I could see the writing on the wall. 1 serious error and my pay could be bumped down to minimum wage! Well, guess what? They found errors. So I just quit. I can’t afford to make minimum wage, and as much as they like to tell you it is an “incentive” program, you could kill yourself and one error will bump you right back down. Unfortunately, the other companies don’t pay much better. My impression is that we are a highly skilled PROFESSION and if we are to be the “guardian of the record” dont’cha think we could be paid appropriately? NO because we don’t make money for anyone. The hospital doesn’t get more money from the insurance company for a patient if there is a properly prepared report than if there was a report with errors. We are a liability to the medical care facilities. They have been trying to get rid of us for years. And I have seen some of those reports typed in India – they are crap!! with a capital C!

    • Lyn
      / 11:15 AM

      Yes it is about the patient’s records and there is no room for errors. The problem with this company is that it doesn’t matter if you have a 99.55%+ quality, it’s about faster, faster, faster. I hear more negative about this company than I hear good and after experiencing it myself it didn’t work out for me either. It is a make or break profession. I’m going back to my former company where I will be appreciated. Yes the pay is not as good as what Nuance offers but at least I will not be threatened every week that my job is on the line. When my quality was up I was told to work faster. When I worked faster my quality went down and again I was told to slow down. When I slowed down to keep my quality up I was told to go faster and lets not forget about all the specs from the hospitals to soak in in less than 2 months. Finally, I worked faster and my quality was so bad I received a call from my awesome manager and HR. I was told by my manager I had 5 weeks to get it together but received a call within 2 weeks telling me my job is terminated. It’s stressful but for those who make it congratulations. I was offered the opportunity to reapply down the road, maybe when I’m better, we’ll see.

    • Cidalia Martins
      / 5:11 AM

      Perhaps doctors should also be trained in the importance of the accuracy of the medical record and learn to produce clearer dictations. There’s no excuse in this age of modern recording technology to have a low-quality recording. Besides the risk of errors, it creates a situation in which most MTs end up spending a lot more time than they should on a transcription resulting in abysmal pay rates. If health care providers had to pay MTs hourly, they’d magically start enunciating words properly and recording better audio.

      • Jenn
        / 3:11 PM

        you are right. I would hope by now they would have better recorders. There’s just no excuse to use crappy ones.

  17. Lyn
    / 2:52 PM

    I too worked for Nuance and had the same experience that Jenn went through and I have 3+ years experience, 1 year in a clinic and 2-1/2 doing psych hospital and more clinics. Somehow I was hired and given hospital acute accounts. Too many to count and then have to know every single little peeve of each hospital’s specs was unbelievable. I was constantly warned to the point where it didn’t matter that my quality was good but then I was told to go faster. When I went faster I made mistakes so I was told to slow down. When I slowed down I was told to go faster. So taking in to account everything Jenn says above is right on the money about this company. I was told I had 5 weeks to get up to par with this company’s standards only to get the phone call from my manager and HR to terminate me, asking if I was alright and did I have any questions. I later asked in an email to HR “Could I reapply sometime down the line,” I was told I could. If you try be prepared to make it or break it.

  18. Sway
    / 9:35 PM

    I worked for nuance for 11 years and this comment is in response to mitzi from back in june. Honey? Sweety? Her comments and way of speaking reek of a mole in that company checking on all these posts. Someone in hr, etc. Exactly what they did to me when i voiced my opinion on mt stars and shortly after, was more or less told “my resignation was accepted.” There was no resignation. Just me speaking my mind. As far as nuance goes, we don’t live in the usa anymore and theres no freedom of speech. Nuance=Nazis

  19. / 9:11 AM

    Not to keep “beating” a dead …I too an employed (presently) with Nuance. This is the first time I really “Googled” Nuance to do some research on the company and came across this site and also MTStars. Let me tell you, EVERYTHING, I mean EVERYTHING that is written about working for Nuance is correct. I was a seasoned transcriptionist who worked for a large hospital in Virginia when in 2012 the outsourced out to Transcend which was then taken over by Nuance. They came in tell us that nothing would change, that we would still be working on the same hospital account and that our pay would be on par. In the beginning it was good but quickly it went downhill as you would expect working on an account you were familial with was costing them to much money. Many of the typist left within 6 months. I stayed on because I was still making good money i.e. was still doing alot of quick and easy reports i.e. endos and hospitalists reports..but all of a sudden the endos disappeared, the easy nice doctors disappeared, I started getting reports that I never did i.e. op notes, cardiac caths, EEGs (don’t get me wrong I love to learn new things but imagine being given a report that you never did, was not familiar with and no one there to help you with). But the straw that broke the camels back was when they came up with a new incentive program in which you were grade quarterly (every 3 mos)..they would do a random samples of your reports for 3 mos and average out your quality score…if your average was 99% or greater you would get the bonus paid to you for the the upcoming quarter (3 months)…I kid you not when I state that for the first quarter from January to March…I did well over 1000 reports they edited 1 report of mines in that time, that report I got a 98.7 score and that was the ONLY REPORT THAT THEY USED. I went in and average my score from all of the reports that I did in FIESTA, and I had a total 99.4 score. If they had average 2 reports, i would have made the bonus, if they had done 3 reports I would have gotten. From then on out I was determined to get the hell away from Nuance as fast as possible. When I had spoken to them about it they said that it was just a coincidence that only one report was audited but I said bullshit, I made to much money the last quarter so the first report that they audited was under 99, so they decided not to do another one and that was done in the middle of the quarter!!!! I have never hated a job more than I hated one working for Nuance…I laughed everytime they would ask us to refer someone to them!!! Fortunately I am bless to not be somewhat financially well off with low overhead so I am presently still working at Nuance but I have found me a new job and will be resigning from Nuance 11/18/2015. The company is designed for you not to make any money…stay away from can make much more money bagging grocery and be a lot happier!!!!!

  20. Anonymous
    / 10:20 PM

    I am SO GLAD I read this…I am close to graduating from my MT course and I was considering working for them…in fact, I am told that my practicum will be with them, unless I want to arrange an external practicum on my own. I wish I had researched this career more beforehand. I feel like I’ve made a mistake a wasted money on the training and nearly a year of my life…not to mention all the stress!

  21. Rajesh Sharma
    / 2:34 AM

    It definitely is Jody, thanks for the kind information and I do hope people read this and attempt to avoid Nuance MT and MModal like big companies.

  22. Miles Myner
    / 1:05 PM

    Wow Jody, Sorry to hear about your bad experience. Here is the low down on Nuance every MT is given different accounts with no clear training on account specifics for the facility they are on. The trouble with that is confusion and chaos. So already it is a set up to fail from the very beginning. Here is the scope on the reason why they do this. They have cherry pickers that pick out the best dictators and the best long dictations if you are running the first Editscript version you can see the cherry pickers in action. Then what your left with is all these terrible dictators and short dictations that is why this company sucks. MModal is by far the best and no cherry pickers.

  23. miles
    / 1:20 PM

    Not anymore now MModal/Aquity QA are filled with the Nuance cherry pickers and now this company sucks.

  24. gorblinorni vil
    / 11:36 AM

    Stay away from MModal/Aquity they have been taken over by the Nuance cherry pickers and even though one
    is paid by the minutes all one gets are short scraps in their job cue so you cannot make money and that is a big
    set up for failure!

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