The Market for Medical Interpreter Certification

In recent months, the U.S. interpreting community has been flooded with information about the importance of certification for those interpreters working in health care settings. Confusion reigns as multiple groups now exist for advancing the agenda of medical interpreting certification. The sheer popularity of this cause begs the question, “Is there a market for that?”
The simple answer to our question is yes. There is definitely a market demand for medical interpreter certification in the United States. To come up with some estimates for exactly how much demand, we revisited the data we collected for our 2008 interpretation market sizing exercise (”TI Supply-Side Outlook” and “Top 15 Telephone Interpretation Suppliers“), along with the information we gathered regarding hospital spending on interpreting services (”The Language Access Ratio“). We also took a look at some data from external sources in order to see if our estimates passed the smell test.
Based on our aggregate analysis, Common Sense Advisory estimates that there are between 15,000 and 17,000 people currently performing medical interpreting work in the United States. This number includes both individuals who provide medical interpreting services as their primary profession – such as full-time staff interpreters, agency employee interpreters, and contract interpreters – and those who provide interpreting services as volunteers or bilingual staff. This number also includes interpreters that may perform work remotely in other locations (for example, telephone interpreters in call centers in other countries), but who provide services for patients and providers in the United States. However, this is a conservative estimate and includes spoken language interpreting services only. Data from sign language interpreting in medical settings was not included as part of our analysis.
Why is this number so large? An enormous percentage of the interpreting that takes place in U.S. health care settings is performed not by full-time medical interpreters, but by those who “occasionally” or “sometimes” interpret, such as bilingual health care workers and volunteers, and these individuals are included in our estimates. Unfortunately, a great deal of medical interpreting is carried out informally by well-meaning family members and friends of patients — not included in our estimates — who often make mistakes that lead to medical errors, misdiagnoses, and complications, resulting in increased costs and inefficiencies for the health care system, but sometimes in the loss of human life. This is one reason why language services play a starring role in the proposed legislation for health care reform.
And, the need for qualified medical interpreters is not unique to the United States. As we stated in our keynote presentation at this weekend’s IMIA conference, globalization is changing the shape of things to come for language access in health care. In fact, the need for more information on language access in health care has prompted us to launch our own research program for health care organizations. However, in spite of the size of this market (both domestic and global), the certification of language professionals is not a very lucrative endeavor. Not only are development costs high, but administration tends to be human-intensive, and human-delivered services cost plenty of money. In fact, some organizations that certify language professionals actually take a loss each time they deliver a test, recovering expenses through other means, such as fund-raising and events.
Over the past couple of years, we’ve received a stream of inquiries about medical interpreting certification regarding Language Line’s prominent role in pushing the certification agenda forward. As we stated before, it is in Language Line’s business interests to make medical certification a reality as quickly as possible — not because it stands to make any significant money from actually selling its own test — but in order to prevent further price compression in its core telephone interpreting market. As our recent research on telephone interpretation pricing reveals, health care buyers pay higher average and median prices per minute than their peers in other sectors. These buyers also place a premium on interpreter qualifications.
Now, two major initiatives are competing for interpreter certification “market share,” and perhaps more importantly, for mind share and interdisciplinary support:
The National Board of Certification for Medical Interpreters (NBCMI). The NBCMI was jointly founded by the International Medical Interpreters Association (IMIA) and Language Line Services (LLS). NBCMI has been holding annual meetings on the topic of medical interpreter certification, with the next event scheduled for May 1st, 2010 in Washington, DC. It is unclear how many organizations support the NBCMI effort aside from IMIA and LLS, but the website states that a list of its board members will be published soon. The NBCMI’s latest press release states that certification was officially launched this past weekend at the IMIA conference, and that Spanish will be the first language available, with other languages offered by 2010. The NBCMI website states that the effort will eventually be a 501(c)(3) non-profit.
The Certification Commission for Healthcare Interpreters (CCHI). Incorporated in July 2009 as a 501(c)(6), CCHI supporters consist of a virtual who’s who in health care, with 28 name-recognizable sponsors, including the American Medical Association, the American Hospitals Association, the American Translators Association, and many others. Also worth noting is the fact that CCHI’s advisory panel includes an expert from the National Organization for Competency Assurance (NOCA), and that some of Language Line’s major telephone interpreting competitors — such as CyraCom and LLE– are sponsoring the CCHI effort.
A third effort, the National Coalition on Health Care Interpreter Certification (NCC), consists of many — but not all — of the organizations that now make up both NBCMI and CCHI. Compared to the other two efforts, this group has not had any recent activity or updates, so it is unclear whether it will continue to exist or fade away in light of the other two initiatives.
This isn’t the first time we’ve witnessed a multiplicity of certification programs for interpreters in the U.S. — diverse programs exist for court interpreters and sign language interpreters — and now, it looks like medical interpreting will follow a similar multi-pronged path. In the short term, we believe that both major initiatives will continue to push forward with their stated objectives, regardless of who launches their test to the market more quickly. In the long term, any certification effort needs backing and support — including legislation, contractual language, and other requirements — in order to be broadly recognized and widely adopted. What really matters in the end is that the majority of those estimated 15,000-17,000 individuals have access to a valid and reliable process for assessing their interpreting skills. Millions of limited English proficient patients are counting on it