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WYPR News explores the future of mental healthcare and The Affordable Care Act.

The Most Important Medical Specialist You’ve Never Heard Of

::: Mer ::: via flickr

As if a visit to the doctor is not stressful enough, many Marylanders have trouble understanding the doctor or making the doctor understand them. That’s where medical interpreters come in, and the need for interpretation has grown along with the region’s non-English speaking population. In the Johns Hopkins Hospital system, for example, there were 17,313 requests for an interpreter in fiscal year 2009. Four years later, requests had jumped to 40,424. And those numbers exclude Spanish requests at Bayview and Howard County General Hospitals, which are part of the Johns Hopkins system. Those hospitals run their own Spanish interpretation programs.

Medical institutions don’t have much choice in whether or not to provide this service. The Civil Rights Act of 1964 bans discrimination based on country of origin, which means providers that receive federal dollars, like hospitals, have to have interpretation. But even though federal law mandates it, Medicare and Medicaid don’t reimburse for it. *George Washington professor Marsha Regenstein, who studies disparities in health care, said that the benefits in health and efficiency are worth the expense. For instance, if a patient can’t tell his or her doctor what is happening, doctors may have to use more (and more costly) tests in order to diagnose him or her. “The per-encounter cost of an interpreter is relatively low,” she said.

What about using an available—and free—family member? Not okay, according to Susana Velarde, who runs the interpretation program at Hopkins’ main medical campus. “Maybe in your culture, you don’t disclose everything that’s going on,” she said, “so you might not want to tell [your] father who's been diagnosed with cancer that that's what he has.” Another big reason she discourages the use of family members and bilingual hospital staff is that they haven’t had the proper training or been tested for language ability.

Though it still exists, Velarde said that the use of family members or bilingual staff is becoming less common as doctors and patients learn how important it is to use trained interpreters. Pamela Bohrer Brown, in charge of multicultural programs for Baltimore Medical Systems, agrees, noting there’s a national effort to certify health care interpreters. She said the Baltimore region ranks “somewhere in the middle” in terms of access to medical interpretation. But she also said that it isn’t easy to guess which regions have great access. “I was actually astounded when I went to…San Antonio a few years ago,” she recalled. While there, she asked local health department employees about interpreters, and heard that they used the bilingual staff. “It seemed to intrigue them that, you know, we were very concerned about having trained interpreters on staff…here in Maryland,” she said.

Outside of Bayview and Howard County General, Johns Hopkins has 18 staff interpreters, dozens of freelancers and contracts with multiple phone interpretation companies. Full-time interpreters might start as low as $18.50 per hour, but can eventually earn as much as $30.50 per hour. Freelance, or “float” interpreters, earn $35 per hour, and weekend and evening hours pay more.

As for training, interpreter Maria Jose Hubbard was a physical therapist in her native Chile, so she already had a grasp of certain medical terms. Arabic interpreter Amany Rishmawi has a Masters in Language and Communication from Georgetown, but still needed the hospital’s training on medical terms. “You have to study really hard because you can't be with patients and mess up and not know the actual term because that's the life of the patient that depends on it,” she said.

Regenstein summed up the need this way: “Most of us find the whole experience of interacting with health providers and the health care system really incomprehensible. And we’re all speaking the same language.”

*Correction: This story has been corrected from what originally aired. Marsha Regenstein is a professor at George Washington University.