By Gerardo Lázaro
Interpreting is a necessity that has played a role in human communication ever since the existence of diverse languages. Today, with more than 7,100 living languages around the world, and as a result of our technological capabilities, communication may be at its peak. And yet, a lack of understanding between speakers of diverse languages has created a growing niche for interpreting and translating.
Spoken language interpreting became renowned during the Nuremberg trials and continued growing with the development of international organizations such as the United Nations. The rest of this article will focus on medical interpreting.
The United States may not be as advanced in conference interpreting as are European countries, but medical interpreting is a field in which the profession has come the furthest as of late. The U.S. health system is geared towards English speakers. Considering the vast diversity of the country’s cultures and languages, limited-English proficient patients confront a barrier when trying to navigate the U.S. healthcare system. Therefore, medical interpreters have become the professionals to help overcome said barrier. Using professionally trained in-person, or face-to-face, medical interpreters, is more time-efficient than using remote interpreting or bilingual employees, which are two other solutions that many organizations use to tackle the language barrier. Also, it has been proven that medical interpreters make fewer errors the more hours of training they have. This may translate into fewer potential clinical consequences.
The Medical Interpreting Profession[pullquote align=”right” color=”#195392” size=”16”]“(…) it has been proven that medical interpreters make fewer errors the more hours of training they have.”[/pullquote]
The medical interpreting profession is still developing. The current trend in the national standard for basic training in medical interpreting is quickly shifting from a minimum of 40 hours of training to a minimum of 60 hours, for non-academic organizations. Academic institutions are starting to offer 100 hour certificate programs. There are also institutions with undergraduate and graduate degrees, in some parts of the country. All of these developments have been taking place slowly over the past two decades. And, the new changes in healthcare, ushered in by the Affordable Care Act, may just be what the profession needs to continue growing and elevating its profile.
The state of Oregon, for example, requires medical interpreters to have a minimum of 60 hours of basic training, including 8 hours on the Code of Ethics. These requirements are also being adopted by healthcare organizations that are implementing comprehensive language access services that include remote interpreting (telephonic and video remote interpreting), using dual-role (bilingual) employees, and face-to-face medical interpreters for patient care.
However, one of the biggest hurdles in the implementation of language access solutions for the healthcare field is the cost associated with contracting with language agencies, or engaging the services of medical interpreters as independent contractors. In response to that, some states have chosen to apply for, and participate in, the Medicaid Reimbursement Program for Language Services, even though medical interpreters are not qualified Medicaid providers. By 2009, thirteen states and the District of Columbia had enrolled in this reimbursement program (Washington DC, Hawaii, Idaho, Iowa, Kansas, Maine, Minnesota, Montana, New Hampshire, Utah, Vermont, Virginia, Washington and Wyoming). Reimbursements range from $45.00 per hour to $190.00 per hour, partially funded by state and federal programs. In 2012, the state of New York joined the list, with a reimbursement of $11.00 per units of up to 22 minutes.
One of the essential requirements for medical interpreters to qualify for this reimbursement program should include holding a national certification. Although this is true in some cases, it is still not required in all states. A national certification for medical or healthcare interpreters was established in 2009 by two certifying organizations: the National Board of Certification for Medical Interpreters (NBCMI), and the Certification Commission for Healthcare Interpreters (CCHI). Both accredited certifying organizations have an identical three stage process:
- Application: assessment of the candidate’s credentials and professional experience
- Written Examination: language neutral, provided in English and meant to assess knowledge of protocol, terminology, and interpreter code of ethics
- Oral Examination: to assess the candidate’s proficiency in English and the target language.
Once a candidate applies for the certification process and meets the requirements, a written examination, offered in various locations around the country, is scheduled. If the candidate passes the written examination with a minimum score of 75%, then an oral examination is scheduled, which must also be passed with a score 75% or higher. The process usually takes between 3 and 6 months, and costs $485.00 (for all the three stages). The only substantial difference between the two testing bodies is in the oral examination. CCHI tests simultaneous interpreting skills, whereas the NBCMI does not.[pullquote align=”right” color=”#195392” size=”18”]“As professional medical interpreters, we aspire to be considered members of the clinical team.”[/pullquote]
Although national certification is a major step in raising the profile of medical interpreting as a respected profession, with standardized testing and continuing education requirements, there are currently only 7 languages available for oral examination: Spanish, Arabic, Mandarin, Cantonese, Korean, Russian, and Vietnamese.
There is not much activity when it comes to offering tests in other languages due to a lack the funds needed to develop nationally accepted, psychometrically validated examinations. There is a disjointed effort between the two certifying bodies to develop different language examinations instead of duplicating efforts. Aspiring interpreters around the country continue to apply for certification and ask about when more language combinations will be made available for certification. The majority of certified interpreters are Spanish speakers, as one would expect, with other languages lagging behind. These are the latest published figures for nationally certified medical interpreters:
As professional medical interpreters, we aspire to be considered members of the clinical team. Obtaining a national certification is one of the main steps towards that goal, but not the only one. Continual professional development and keeping abreast of the latest national trends is not only recommended, it is necessary. Joining professional organizations is a major step in that direction. There are several national organizations such as the American Translators Association (with a growing medical interpreters division), the International Medical Interpreters Association, the National Council on Interpreting in Health Care, as well as state and regional organizations throughout the country. The California Healthcare Interpreting Association (CHIA) is perhaps the most well known, but there are many more.
If you want to become a professional medical interpreter, what should your next step be? The answer includes taking a course of 60 hours (or more) of basic interpreter training, sitting for one of the national certification exams, joining professional organizations and attending their meetings and pursuing continuing education units to maintain your certification and continue improving your skills. So, what is your next professional move?
 Grover, A., Deakyne, S., Bajaj, L., & Roosevelt, G. E. (2012). Comparison of Throughput Times for Limited English Proficiency Patient Visits in the Emergency Department Between Different Interpreter Modalities. Journal of Immigrant Minority Health. Journal of Immigrant Minority Health, 602-607.
 Flores, G., Abreu, M., Barone, C. P., Bachur, R., & Lin, H. (2012). Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters. Annals of Emergency Medicine, 545-553.
 Youdelman, M. (2010, n.d.). Medicaid and SCHIP Reimbursement Models for Language Services (2009 update). Retrieved from Greater Cincinnati Health Council: http://www.gchc.org/wp-content/uploads/2011/07/Medicaid-and-SCHIP-Reimbursement-Models-2010-update.pdf
 The National Board of Certification for Medical Interpreters. (2014, n.d.). Certified Medical Interpreter – Candidate Handbook. Retrieved from The National Board of Certification for Medical Interpreters: http://www.certifiedmedicalinterpreters.org//sites/default/files/national-board-candidate-handbook.pdf
 Certification Commission for Healthcare Interpreters. (2015, June 17). Interpreter certification and skills maintenance as key elements of quality assurance. Retrieved from Certification Commission for Healthcare Interpreters: http://www.cchicertification.org/images/webinars/2015-06-17-cchi_certification-quality_assurance.pdf
Gerardo Lázaro is a Certified Healthcare Interpreter (CHITM) and he works at the National Institute for Coordinated Healthcare (NICHC). He is a Master Medical Interpreter in the Philadelphia Metropolitan Region hospitals and is developing training programs for coordinated healthcare and cultural competency. Gerardo has been a lecturer and trainer of educators in Perú, Colombia, Argentina, Brazil, Spain and the United States. He has a BS in Biology, a BA in Education and Master’s in Education, all form Perú, and is a Ph.D. candidate in Public Health here in the USA. He is interested in improving health care outcomes, primarily for underserved populations such as low-income, immigrants, and the limited-English proficient. He can be contacted at firstname.lastname@example.org /