Development of the Medical Interpreting Profession in the US: A Case Study

Introduction

Although interpreting is an activity that dates back to prehistoric times, it did not become professionalized until the 20^th century (Baigorri, 2015; Pöchhacker, 2004, p. 28). In particular, medical interpreting (also known as healthcare interpreting) arrived rather late on the scene, at first being viewed as a part of community or public service interpreting and then gradually emerging as a separate specialization in the 1980s (Pöchhacker, 2004, p. 15; Pöchhacker, 2011, p. 220; Roat & Crezee, 2015, pp. 238-239). Although in the 1970s Australia had been the first country to establish a service to provide interpreting (over the telephone) in a variety of community settings, including medical facilities, interpreters did not tend to specialize in a particular setting at that time. In the 1980s, a few hospitals in Canada and the United States began to provide interpreting for patients using paid interpreters. Similar efforts took hold in Europe, albeit sporadically (Roat & Crezee, 2015, p. 238). It should be mentioned that even though the interpreters were “professional” in the sense that they were paid employees rather than volunteers, they received little or no training and were hired based on self-reported bilingual proficiency.

During the following three decades, the number of job openings for paid interpreters and training programs for preparing them steadily increased (Tipton & Furmanek, 2016, p. 1). According to Tipton and Furmanek, “the countries with the highest influx have naturally become prominent players in the field of healthcare interpreting practice and research” (p. 116). They cite the United States in particular, with the United Kingdom and Spain being the European leaders in this regard. Outside of Europe and North America, they mention noteworthy developments in the United Arab Emirates, South Africa, Chile, and Mexico. It is significant that sign language interpreting, at least in the United States, became professionalized earlier than spoken language interpreting (Downing & Ruschke, 2012), though even among sign language interpreters, healthcare interpreting was not recognized as a separate domain until relatively recently (Swabey & Malcolm, 2012, p. ix). Despite this slow development, however, it can be said that now, in the second decade of the 21^st century, medical interpreting is in the process of becoming a full-fledged profession in its own right, with national standards of practice, training programs at accredited colleges and universities, and certification exams as a prerequisite for employment in salaried positions—all typical characteristics of a profession, according to Abbott (1988), though these elements of professionalization are not as ubiquitous as one might desire (Pöchhacker, 2004, pp. 29-30).

This chapter is intended to trace the development of the medical interpreting profession in the United States as a case study to illustrate a general pattern that has emerged in many countries, at different times and at different rates. It will begin with an overview of the different conceptions of the role of the interpreter in healthcare settings. The importance of government participation, in the form of legislation and regulation, will be examined, along with the role of hospital accreditation bodies. The chapter will also illustrate how professional organizations have been key players in the professionalization of medical interpreting, mainly by establishing standards of practice and developing certification programs based on valid and reliable assessment tools. Efforts to train prospective interpreters to enter the field and to provide continuing education for working professionals will be explored, describing degree and certificate programs at different levels of education. After analyzing the current labor market for medical interpreters in the United States, the chapter will conclude with recommendations for the future. Thus, the overall objective of this chapter is to show how the profession of medical interpreting has evolved in one country so that lessons can be learned from successes and disappointments as other countries replicate its experience.