Localization Fireside Chat
The Future of Medical Interpretation: Certification, AI, and Global Standards | Fireside Chat Ep. 78
(upbeat music) - Good morning everybody. This is Robin and you from the localization firesite chat. And today, welcome for another episode for another recording. Today, we are recording episode number 78 on the channel. And just news to everybody I'm celebrating today. Actually, there is a 280,000 views in total on the channel. And somebody in the industry just ran a statistics on all the YouTube channels are in the industry. And fortunately, my YouTube channel, the localization firesite chat, which is started in March, 2023, has now ranked number 11 in the entire industry, which is pretty significant achievement, knowing that I don't have a marketing department supporting me. I don't have a large budget pushing this forward. I call it the fuel of passion. That's what it is that is pushing me forward on this one. So again, to the panel that we have today and to the audience, welcome to another episode. Welcome to this recording. Today's topic is going to be medical interpretation and the important of the profession of medical interpretation. In when it comes to life-saving conversations that the patient and the doctor, the service provider, are having together. And the enabling of those conversations to go in the right direction. Most patients or most health service providers don't speak each other's language in some cases. And this is where this particular conversation that we're going to be having today, it's very important. The conversation that we're having today, it's not new. It's not the first one that we've had. We've had another conversation about two months ago now. It's on the channel with the panel that you have in front of you. This is a continuation of what the previous episode that we've recorded. Feel free to check out our past recording of this same topic. And to help me guide me through the conversation today, I'm honored to have with me the lady that we've had before with us on the call. And for those who don't know you, if you don't mind, let's start with a round of introduction. We'll start with Natalia, if you don't mind Natalia, introduce yourself. And then go to Jenny, Erisa and Mila. Go ahead Natalia. - Hi everyone, I'm Robin, thank you for inviting us back. And my fuel for passion is like a languages. I love languages, so I started my career as teaching them both at high school level than university level back in the southern city in the Russian Federation. And when I moved to this country, my first job was coordinating interpreting and translation services for a refugee resettlement agency. And this is where I discovered how difficult it is to learn a language when it wasn't your passion from childhood and how to become an interpreter is actually, you need to follow certain steps, certain paths. And I developed at that point some trainings for refugees who are brand new to the United States and who speak some English, but they don't know anything about interpreting yet. And soon during that work, I realized that the crown for any profession is actually certification. And the profession exists on the map, on the radar of the HR, on the radar of industry. It would have some standard that you can compare against. And that's why I volunteered for and was one of the founding commissioners for the certification commission for healthy interpreters, CCHI. And here I am for the 15th year with them. And for the 10th year, I'm the executive director of CCHI. - Well, welcome. Nice to have you with us, Jeannie. - Well, Robin, thank you so much for having me back. And in this great company, I'm Jeannie Bromberg. I started out as a freelance interpreter in the industry. And I'm actually a court certified interpreter, though I don't get to practice, unfortunately, as much as I would like to, because interpreting is my passion. I run two companies, Bromberg and Associates. I'm the founder and president of our language and technology solutions company. We're working over a few hundred languages. And healthcare is definitely one of our important sectors. Our second company and the one that started out of, I have to say, out of sheer frustration with the lack of training options at that point was language educational mine. Initially, the title of the company, the name was interpreter educational mine, but later on, we were granted to reflect the growing array of training options. And today we do training, testing. And since 2020, we started doing conferences for the industry, everything online. And in addition to that, I'm happy to give back to the industry. I am on the board of association of language companies. And I also chair language access committee through the ALC. So it's my pleasure to be here. - Excellent. Well, thanks for joining us today, Jeannie. - And Risa, good to see you again. - Hey, hello, everybody. It's great, actually, to be back. So thank you. The reason that you invited us is because we did a great episode last time, I guess. So thank you for having us again. It's a pleasure again, it's an honor to be here with the amazing ladies that I admire very much. So I started in this industry from the other side. I was a medical student. So I spoke Albanian because I was born and raised there. And I moved to United States with a dream to help people. But then by coincidence, I was introduced to the profession. I fell in love. And my passion, my field of passion, is not only to serve the client, to help the people who do not speak the language in United States or everywhere, but also to help the linguist. Because I think that my mission in this industry is to bring this great opportunity to serve globally. Because there are many, many linguists worldwide that would love to learn, would love to get trained, certified, and help connect the communication between language barriers. So I run the linguist survey with the mission to promote a linguist interpretation worldwide and also serve US patient and US companies as well. Thank you. - Thank you, Ursa. Thanks for joining us this morning. Mila. - Thank you for having us, especially for the second time. I too started years ago as an interpreter. Certification did not exist in this country at that time. It was a big shock for me. And I actually seeked a version of what would be a certification and took the State Department exam as a way to show that I'm actually a professional working in this industry was the only thing available at the time besides court certification for Spanish Navajo. But that wasn't my language at the time or noise it now. So years ago started as an interpreter. And today I'm the founder and the president of Masterword. We work in over 450 languages because we have a very strong emphasis on marginalized languages. And we started what has now become Masterword Institute years ago. And we have a lot of different training programs and training options for interpreters. We very much support CCHI and partner with CCHI and we're thrilled that now CCHI has a new exam for the covers marginalized languages. So we'll be outsourcing more of our tests. We're looking for CCHI certification for all of the languages. And one of the focuses of my work or volunteer work has been in addition to founding global coalition for language rights. Also focusing on vicarious trauma that affects a lot of interpreters and with the goal of educating as many interpreters on the topic. Trauma informed interpreting. Cannot talk about it enough with the epidemic of trauma. How important that is. And then interpreting in the field of human trafficking and trauma survivors. Again, survivors of violence, working with refugees. We see a lot of that in our everyday work. So healthcare interpreting is critical. So the lives are full. - Well, thank you very much, Mila, for joining us as well. Thank you ladies for joining us. Again, backed by popular demand. We restart the conversation and we expand on what we've started talking about. This is an indicative of how important this topic is for many people, many, for many on many levels. So one of the things that I would like to get us started in terms of this particular conversation today is, let's talk a little bit about medical interpretation in the US today. Like I know you guys, you ladies operate in variety of states. I don't know if you cover coast-to-coast, your services. Do you have like a specific jurisdiction that you operate in? Or do you have a specific medical practice that you offer services in or all medical practices? And where does it fit from the other side of the other branches of medical interpretation would be, for instance, one is mental health, would be physio therapy, would be on all the other extended benefits of healthcare, if you will, not necessarily just the hardcore one. The one that you have to actually sit down and explain an illness per se, a physical illness. Let's start with Natalka and we'll do a round on that topic. Just give us your opinion if you don't mind on what I just commented. - You know, I mean, this is a good question. We're a national organization because from day one, we thought that it's important that medical interpreters have one standard regardless of what state they're in in the United States. Because especially with it, at that time, the onset of remote interpreting, video remote interpreting, it truly is important. You never know whether the interpreter you are getting, being in rural area of Ohio, if that interpreter is from Ohio or if they are from the state of Washington or maybe even Canada, right? So for that reason, we have this national certification that is the same for every language and every interpreter. On top of that, you brought up a very important part. Medical interpreting is not just talking to a doctor when you have like, you know, come to get a vaccine or when your child has an earache, right? Medical interpreting is healthcare in general, and it may be mental, health, dental, physical therapy. And so on our exams, obviously, we cannot cover every single thing, but because we update our exams like regularly, every other year, we do have sections that touch upon terminology of all aspects. And the same thing with our practical exam, we have dialogues from different specialties of healthcare. And that's why our brand is healthcare interpreting rather than narrow word of clinical medical interpreting. And that's, I think it's important because you may start as a staff interpreter in a hospital and think that's what you'll do all your life, but that doesn't happen that way. And so tomorrow you may be doing something completely different. I'll stop here. - Absolutely, thank you, Natalia. Do you need any comments on your side, on the comments here? - If I can just unmute, then I can comment. Yes. (laughs) Well, definitely. And I think that the profession has advanced quite a bit in comparison to like thinking back 20 years ago when I would see janitors and cafeteria workers who happen to be bilingual, being full to interpret, you know, delivery, mental health, any type of an appointment. I'm not saying that it's not happening today, but because it is, unfortunately. But I think the extent to which it is happening today is nothing to compare to what it used to be. So profession has made a lot of progress, a lot of strides. With certification with interpreters who are at least core, certified, if they don't have CHI, they can have core CHI. So it is getting better. There is a lot more awareness in the industry with regards to hard skills, soft skills, and specializations. So that I think is a great step. There are also some challenges, obviously, and we're not where we do need to be. So there is so much more work that needs to be done with regards to advancing the profession. And I'll stop here because I'm sure that that will, me, Lynn, every second, add a lot more. - Thank you, Ginny. Erisa? - So I'm an interpreter, myself. So I will share with you a story that happened recently that kind of brought me very, very joy because there was a doctor that asked the patient, why didn't you bring your daughter to help us communicate? And the patient said, no, I like the interpreter better because they interpret the medical terminology much better than my daughter. And I felt like, yes, this is what we're talking about. This is what we have to strive every day to make a difference, not just to help them understand, but to the level of communication that the patient feels secure, feels safe, feel that they can trust the person on the other side interpreting for them. And a family member or a bilingual person cannot offer that. But to reach to that level, we definitely need standards. We definitely need more training and we need more support for our interpreters because interpreters have the passion to help. But in order to be to the quality that this professional requires, we need to provide all the resources. And thank God we have companies that provide this training like Genius Companies or Mila's Companies that help interpreters learn more, grow more and then go certify them and be accredited nationwide. So I think I agree with Jeannie that there is a lot more to be done, especially when we go back to my sweet spot, international global resources. Those are a little bit more like a way taking this ratio where the US interpreters are. So we need to close this gap. We need to make standards not only national, why not international? Because healthcare interpreting is viable anyway. - Great. Next, Rista. Mila, what's your take on that? - Well, I will be adding to it. We work nationally and we work across all parts of healthcare. So, and yes, there's been progress in healthcare. However, there's a great presentation at CCHI conference that talked about how even within healthcare what percentage of doctors don't know and don't even call an interpreter into an encounter. But if we go outside of the hospital setting, we have a lot of work to do educating the clients about using the interpreters and how to work with interpreters. So there's still a lot of work to be done. I also think that at this point, while we have done a lot of work establishing certification and there's a lot that falls on interpreters to continue education. For example, I was preparing a training course on how to interpret in synergetic place therapy settings. In order to do that, I took a six months, full time pretty much training course with synergetic play therapy professionals to understand the field. So as we're stepping forward, moving forward, there'll be even more requirements on interpreters to improve their skills. And especially, and I'm going to touch that topic as we as in the age of AI, we're not stepping into the age of AI, we're in the age of AI. So now we are also in a way competing with AI in the mind of a provider who goes, why don't I just get here chat GPT or Google translate and use that to facilitate communication. So we have a new challenge that centered our industry. - Absolutely. So the next, we're gonna save that AI question to just a little down the road in our conversation. But why next topic that I'd like to bring to the panel is for those who don't know, what is the mechanics from a providing the service perspective? So for instance, if I was, who do you sell to? Do you sell to the hospital, do you sell to the doctor? Do you sign a contract with the hospital? Do you sign a contract with the medical system in the state that you're in? How do you, who is your customer A and B, how do they book an interpreter, for instance? Do you guys have a software that they log into and book an interpreter or they phone you? Are the interpreter needs to be flown into some location? Or are they, they live handy around the area where the service is being provided? And those are the mechanics of providing the service, I guess, can we go around just to get an idea of how the service is provided and who do you sell it to? And how do they book it? And for instance, what is the minimum rate? Like is there a minimum rate of, you know, do you pay them per hour? How do they interpret, or can I make a living being an interpreter, or am I gonna get one assignment per week? And that's it, how does that work? - Well, Jenny, I'll let you do the second part and the others, but I'll say all of the above, Robin. So we sell to hospital systems, we sell to individual hospitals and individual doctors. The options for having a contractor all of the above and the options for booking the service are all of the above. Most companies today have a software where there's a portal where you log in to a portal, you request a service, some organizations and some groups they call in, they prefer to call in, others prefer to log in through the portal. And so as far as being able to access the service, companies in the industry today provide a lot of technology. And I'll let the rest of the group cover the other answers. - I can continue on what Mela was talking about. And yes, all of the above is exactly the same answer for us. We do offer software technology for our clients and they can log in the request services through the portal. We do provide services remotely on sites, however the client needs. It is rare on our end because we do work with government and healthcare entities that they would approve somebody to be flown in, but they would rather figure out or we would rather help them figure out options to deliver services remotely. But with regards to making a living, I think it depends on the language peers that the interpreter works in, whether they're open to working remotely on site, whether they are flexible with how much work they want to put in. It definitely is an opportunity to make a good living for someone who is trained, certified, specializing and willing to continue lifelong learning in this career. - Absolutely. Someone who takes it seriously as their career, yes, they can make a living. - Like any other career, right, Jeannie? - Exactly. - Exactly, absolutely. - So who pays for the service? Is it the patient? Is it the doctor? Who pays for the service? - So may I? - Go ahead. - Legally, we have laws in the US that require language provision to be offered by hospitals, by healthcare organizations, by any federally subsidized organizations to the patients and now to their families as well. We just recently had the final ruling for section 1557 of the Affordable Care Act go into effect, actually just a little over a month ago. And it expanded the requirements quite a bit. So now, for instance, Medicare Part B, so smaller providers, smaller clinics are now covered as well. And they are supposed to provide proactively language access. - And if I can jump in here, so what it means is that in the US, patients do not have to pay for interpreters. It's a responsibility of any provider of any health systems. I also want to add to your conversation, you were talking about Mila and Jeannie of about one part of our workforce as medical interpreters, which are freelancers. It's important to recognize that in the US, it's pretty much 50/50 split now, at least according to the service that we run at our organization. The other 50% are staff interpreters because health systems, especially in large metropolitan areas where there are patients of kind of rather narrow type of languages, like maybe five, eight languages. And of course, regionally, it could be like, in the state of Texas, it could be just one language, Spanish, right? So they have staff interpreters. And if you're a staff interpreter, then you follow the same and get the same benefits as any employee of a health system. So that way, you can definitely make a good living. You have health insurance and all the other bills and whistles that come with that retirement, et cetera. So that's one aspect. But it is rather limited number of jobs because smaller hospitals and smaller clinics will not have staff interpreters. So that's why I think we have like three types of interpreters in the country. Staff, full time, go to job, come back home, do nothing else, right? Fun. After that, it's fun. There's a mixed group, which is they like staff, but they're on call in hourly. So they could go maybe 20 hours in that main provider. And then they supplement it with, you know, remote interpreting, usually call in because they have enough of the face-to-face for the day, then they sign in. And they're different models. Some companies allow you to sign in whenever you're available. So if you're available this week, two hours, you work two hours. If you're available this week, 40 hours on top of your other 20, you'll do that, right? And then there are the freelancers. That's, again, it's up to the dedication and desire. And as far as making a living, for freelancers, you know, I worked mostly in my previous job with interpreters of languages of lesser diffusion, so to say, which will be like Karen, Nepali, Mon. So at some point, when we just started resettling refugees from Myanmar in this country, we only had two interpreters who spoke Mon. And one of them was in Hawaii. The other one was on the East Coast. And so they had the whole United States. And they were, unfortunately, not always available because we have to sleep, right? And at that point, because of such a rare language, it's the first, and I'm talking about the first year of starting the resettlement of that population. They could definitely get enough, you know, to live. But now when we have more of the population, of course, you know, the market takes care of that. So it's a flexible thing. And that's why it's so hard to explain to the providers how we work. And that's why nobody really understands us even in the United States because, you know, you talk about this, that, and it's just a nice, you know, mix, but I think it's also a great profession if you are so flexible and if you're searching what you want to do. And I'll let Ariza talk about that since, you know, she was the one who found the profession. - Go ahead, Ariza. - Yes, yes. So I agree with everything that has been said because I want to mention one aspect considering on how much you invest to become an interpreter. So yeah, you get paid very highly if you're a doctor because you invest 20 years of your life learning about that profession and a lot of that to finish medical school. So as an interpreter, you don't have that burden. So at the same time, the correspondence is not as highly, but I agree with Natalia if you are a full-time staff, the payment and the benefits in U.S. are very similar to everybody else. The idea here is how you distinguish yourself because the competition is real even among interpreters. And just knowing the language or finishing one training course is not enough and it will never be enough. So one thing that interpreters have to realize in order to compete real and have a fair advancement, they have to work on their selves or on their journey, on their progression. But one thing is that our industry has a good relationship with technology. So we are very advanced in technology as far as I see when I start, and I didn't start very long time ago, but it changed it like automatically, dramatically within like a couple of years. So now in terms of providing our services is very easy, you have a lot of options, you can do video over the phone, you can do in person, you can schedule, you can reach anywhere nationwide and globally as well and in terms of in matters of seconds. We connect in 13 seconds. So that's something unique for doctors to save their time. And I want to add to this. So we kind of skipped over people who speak rare languages and people who want to work as interpreters for rare languages. I think for any language in our field, there is a requirement for lifelong learning and professional development. And I've seen interpreters who speak the most rare languages, who actually are fluent in location to location, the better they become, the more in a way they get a celebrity status. And they are the ones requested for the most important appointments, for the most important assignments. And we see with rare languages where appointments are scheduled based on interpreter availability, sometimes not based on the doctor's availability. Court hearing is scheduled based on interpreters availability, not based on the doctor's availability. And interpreters who pursue that continuous learning, professionalization for those rare languages get full-time employment because they become required, requested nationwide, and sometimes internationally. You know, this is very insightful. And I really-- I like this conversation where this conversation is going. You guys are providing a lot of information here for people who are potentially thinking and becoming an interpreter, who are currently an interpreter, it's educational for them as well. And for the people who are requiring the service, just to understand how serious this conversation is, not just because you speak another language, you become an interpreter. There's a lot more to it than that. That's also education. And for the service provider to understand, these are not the local support staff that you have in your hospital or in your health care facility that they're doing the job. These are qualified individuals that have been vetted, have been certified, and they're providing the service. Now, you guys operate in the US. The US community in general is a litigious society. I mean, everybody soothes everybody. That's the understanding I have of the United States. Any opportunity to sue somebody, people will take it on. How do you manage that? And the doctors are being sued. The hospitals are being sued. What is the liability protection? Or have you ever been sued from an interpretation perspective? How did you manage that? How did you deal with that? Can somebody talk about that? Actually, let's start around the round robin discussion on the legal aspect of it. I can jump in. So first of all, insurance to carry insurance. Secondly, it's an incredibly tight vetting process. So we have, unfortunately and fortunately, about initially about 5% right now with more trained interpreters in the industry. And we have about only 15% pass rate for proper. So we do look for hiring really professional interpreters. So it's really tight screening vetting. And the onboarding process is a very, very important part of that liability management. And I'll pass that on. Let me jump in here. So I want to clarify that there are two aspects to lawsuits, right? One is about interpreter doing something wrong. And those are very rare if they were used to professional interpreter. Our profession, unfortunately, suffers from the fact that the public would call an interpreter anybody, right? And we would have the infamous example. I don't know if it's a widespread across the world. But in the United States for two decades, we have one example that a hospital was sued because the person became quadriplegic after the interpreter made the mistake of saying interpreting the word intoxicado as intoxicated instead of poisoned, right? And so it was a 7 million settlement for that thing. But that interpreter was not an interpreter. It was a person who was an emergency responder who was used to interpret at that moment. And so the majority of the lawsuits in the United States and our industry are against the systems and providers who did not utilize professional interpreters or did not provide any interpreters period. And that one law that just came into effect that Gina mentioned that section 1557 now gives the opportunity to for any person and any organization who observes that gap and the interpreter is not provided to sue that health system. So anybody could bring it, it could be a person themselves, it could be an interpreter against the health system that they did not provide the professional one. So that's kind of with the nature of the litigation. And to my knowledge, we have not been sued on this call and any of us. Now for the CCHI, because we also carry the liability without we exams, our main protection against lawsuits because certified interpreters carry that brand that they have been tested is to make sure that our test processes are in compliance with the best scientific methods. And that's kind of what protects us. If at any point a certified interpreter is brought into court and has to prove that they actually qualify to do the job. - Absolutely, thanks Natalia. Dini and Erisa, anything to add? - Well, I'll definitely second everything that Mila and Natalia have said and insurance and vetting processes are incredibly important. And I would say vetting processes and qualifying interpreters is more important than insurance. Insurance you carry not to use it and processes you continue to improve because requirements continue to change and be modified. So from that perspective, I agree with Natalia also, there have been a lot of lawsuits when interpreters were not utilized or when family members or no one or Google translate were used. So I just wanna make this parallel. We always talk about, oh, a family member was interpreting, unfortunately. And I think Natalia mentioned something about that in the language industry, it is fairly common to have someone who is not a professional interpreter still be involved. We don't see that with doctors, nurses, any other medical professionals. So we shouldn't be seeing that with interpreters either. And I think that's a really important point for everyone involved, including patients. But for that, they have to understand their language access rights and be empowered to enforce them. - Great, thanks Dini. Risa? - So I'm gonna say one last thing is that when you enter into the journey of becoming an interpreter, the first thing you learn is code of ethics and standards of practice. And the first thing you learn is accuracy. And we make sure that all of our interpreters, everything that comes out of their mouth and know they're liable for everything they're saying, not in terms to make them, you know, that this is something that can happen, but just to differentiate a professional interpreter for just a bilingual person that can summarize or forget things or not mention things. That's why I totally agree with the ladies that if you use a professional interpreter, you will see the difference, the hospital see the difference, the patient sees the difference a lot when they use their family member or when they use an interpreter. So once that we come to a realization that professional interpreters aren't like everybody else in the healthcare that is a professional that shouldn't be substituted or shouldn't be, you know, let's pretend we have it, everything else should be sure and reassured that the job is done well. - And I wanna add, again, one more point. I wouldn't be on this call if I wouldn't be talking about trauma informed. There is an epidemic right now due to obviously, we're all now in the digital age. And after COVID, there is an epidemic growth of human trafficking cases, child abuse cases. And obviously, we see as the global increase in number of refugees due to conflict. Doctors are often on the front line of identifying those abuse cases and trauma cases. And for that reason, in the trauma informed training, they are telling doctors to actually have the mother step out of the room, have the father step out of the room, have the family member, even in pediatric encounters, step out of the room. And that's where professional interpreter comes very much in play and is also additionally very important. And that is to identify properly cases of abuse. So not only it is important for accuracy of interpreting, it is important for saving lives out of abuse and trauma situations, saving children to work with professional interpreters. - Absolutely, absolutely. Now, giving all this and giving the, and there's two more topics we're gonna talk about is the competition, meaning that if I was a service provider and I understand now, it takes certain qualification to become an interpreter. It takes a certain testing to become an interpreter. It is not just walk off the street and speak another language kind of an interpreter. It takes a lot of investment for you as a company and for me as a personal or person as an interpreter to become an interpreter. Which, how do you balance, I guess, the question becomes now, how do you balance between your rates? Like, you know, somebody comes in and say, you know, I offer this for, I mean, we're seeing it in every service, right? And I'm assuming it is in your world as well, where you're probably asking for X and your competitor are asking for 50% on the dollar or et cetera. So I don't know how you guys manage this. But how do you balance all this? Let's start with, I guess, with Mila, you said you had the microphone, I guess. - All right, thank you. Well, first of all, I believe we're not allowed to talk about the rates themselves. - Not specifically, no, just in general. - Competition, we manage it by staying professional and by, we've actually increased rates in some cases. We are, people who are going to the rock bottom, the rates to the bottom are doing disadvantage to the whole disservice to the whole profession. I believe, you know, it's very critically important to pay interpreters more, to pay, and therefore to charge more. And so I'm actually going to open it up to the rest of the audience here. I think it's what we do when somebody under cuts us, we ignore it, and we say we're going to either lose that job, completely, that's fine, but we're going to stay firm because we believe in paying fair rates to interpreters and to everybody who works. There's a whole large group of people who work in talent acquisition, talent management, accounting, training, all infrastructure that supports interpreters. Jeannie? - Thank you. - I agree, I absolutely agree. Race to the bottom undercuts everybody in the profession. You can't have fast, good, and cheap. You can only pick two at the most. So we take out the cheap. And I absolutely agree with Mila. We do submit quite a bit of proposals in response to various requests for quotes, requests for proposal, et cetera. And whenever we see that it is going to the lowest price technically acceptable type of a scenario, we may either choose not to bid or bid at the rates that we think are fair. And sometimes we win, sometimes we lose, but we are not willing to compromise quality just to go to the lowest price. I don't think it improves the profession from any angle. - So am I hearing that this is a company decision? You guys don't have like a national way of setting the rates, like for instance, when I worked for a long time ago, I worked for an insurance company. And there was a fee guide, meaning that if you are a dentist and you're having a root canal on one side of the country, you'll know how much it's gonna cost you for a root canal on the other side of the country. It's the same dental fee guide. It may vary a little bit of up and down by the cost of living in certain states, but it's pretty much give or take the same rates. In this case, we're talking about individually company or individuals setting their own rates. Am I correct? There's no national way of setting rates for you as an intern, correct? - In healthcare, for the most part, at least in my experience, I have never seen a standardized national guide. And it wouldn't work because different parts of the country have different language requirements, different cost of living, and therefore, it would be detrimental to the industry. I have seen it in other verticals, but since we're focusing on healthcare here, I can stick to healthcare. - Yeah, yeah. Natalia? - And I think part of it is also because there is a workforce that has staff interpreters, right? And that kind of balances things out, especially in some states. And I'll give examples, like states of Washington, Oregon, California, who have higher requirements towards interpreters and the quality of interpretation. And they have a staff position which would be higher paid that somebody in the middle of the country, right? So I think that also creates this hard to compare. And that's what makes our industry medical interpreting unique because there are some contracts. And obviously, there are big buyers of conglomerate buyers of interpreting services that then go out and bid and then you sell it to individual health systems. But it's still not a unified bidding thing. It's not like there are, I think there are maybe two or three big contractors like that who do aggregate purchasing of interpreting services. And another factor here is what ERISA keeps bringing up is the fact that remote interpreting in the United States is still global. It's not just purely local talent, right? And otherwise known as offshoring. So whichever way you want to call it. And because of that, of course, the cost to employ interpreters in the countries outside of the United States will be cheaper for many languages, for most languages. Another thing to keep in mind, I would say like at least 80% of interpreting is Spanish in the United States. And for that, there is a huge demand and there is a huge opportunity to aggregate and to offshore more. So it's hard to compare. So if you're talking about interpreting of Arabic, Burmese, Ukrainian, it'll be a different story than interpreting in Spanish. So it's important for both purchases and bias to recognize and interpreters too, that you'll have more flexibility if you are a Ukrainian Burmese or so a heel interpreter than with your Spanish interpreter. - Absolutely, everything to add on. - Yes, oh my gosh, I have too many things to add. So the first thing I want to say, the cost differentiation, it's a huge factor in our industry. Of course, especially when we're talking about clients, there still are not very, very much aware of the role of the interpreters. They think that as long as they are interpreters, they're everybody the same quality. I totally agree with Natalia that offshore, not only this industry, but in all the industries, offshore is seen as an opportunity to reduce costs. And that is the case even in our industry. But the fact is that we are talking about interpreters and the quality and the standards should be the same, no matter where they are located. The companies that provide outsourcing, and my company is one of them, it's suffering as well in this cost reduction model, because everybody feels like I can go and find resources in like a lab of a moment, many resources at one time. But the idea is like, how are they vetted? How are they qualified? We're talking here like 40 minutes, 45 minutes about the standards, the quality, the practices. We have CCHI in the United States, but there is no CCHI outside of the United States. There is no standardization outside of the United States. So all of this makes that the coast outside is very cheap, but even the cheapest has to has a limit because that comes back from the interpreters being frustrated, being unhappy, being demotivated because they feel the burden the most when it comes to the coast. So I think that there is no standard in our industry and my experience as well in terms of pricing, but should, I agree with Mila and Jeannie that every company should wait if they believe in their quality, do not have to struggle right now in terms of, oh, let's reduce our cost as well, because this will come back because nobody will jeopardize the quality of the interpreting for just the reduction in price. But at least I think nobody should in this matter in healthcare interpreting. - I guess I keep weighing in and adding up some countries actually ahead of the U.S. on this. Australia's certifications and requirements are way ahead very often we look up to them. We have UK, we have different countries in Europe. And so when there are many countries that have very strict requirements, but some countries don't. I wanna add one point, what we are seeing in two things. One is an increased requirement for U.S. only labor in the U.S. and a lot of government and healthcare contracts due to confidentiality. But second is with this kind of alarming. We have been seeing cases both in the translation side where the companies are using machines, AI or MT, and then post editing and labeling that product as fully human. And the same thing we're seeing when sometimes companies offshore now labeling that product or that service as fully onshore through certain loopholes that are potentially available. On that right now, ASTM has a huge effort for written work on labeling and coming up with a process of labels where machine output will be required to be labeled. - Great, and which brings me to the last point on this call today. And thanks, Mila, for driving us into the last point. Is AI and where is it being used now? What parts of your business is AI being used in? Obviously not all your businesses being using AI, but I'm assuming at some point in your process, we are using some parts of AI. Let's start with Mila. - Okay, so thank you. We're using AI or we're experimenting with AI because machine translation and translation memory have been in the industry for years. So they're part of standards part of the process. We are definitely using AI where we automate other parts of the business. Processing of invoices, the parts of the business that can be automated that don't have to do with the linguistic component of the work. And at the same time, we're staying on top of the evolving technology and experimenting and testing it. The types of encounters we are providing for interpreting, we wouldn't feel right now ethically right to provide machine interpreting for those types of encounters. Are we experimenting? Yes. So I'm automating manual portions. So let's say renaming faxes is done by machines. - Yeah, absolutely. Let's say Arissa, what do you think on the topic of AI? - AI is everywhere. So of course the influence has been seen in our industry as well. So in our company, we use AI in terms of because we're focused a lot on training our interpreters. So we use AI to be a tool to help our interpreters to get familiar and also in terminology and also maybe as a resource to increase their terminology in specific areas or for specific scenarios role plays that we have part of our training. But in terms of being afraid because in our profession has made a big question mark if AI will substitute an interpreter and some people are afraid to enter into this journey because of the future. I think I've heard it many times and I second that opinion that if an interpreter is qualified, is specialized, it's very good. I don't think AI will catch up to that level. So I think we in every profession, we have to stand up and we have to be better and we have to combine our forces with AI. So I think it's beneficial. - Absolutely. Jeanie, where do you stand on this topic? - Well, AI can be great or it can also be very helpful in process automation in improving outcomes in running the business. - Okay. - So from that perspective, we use it, we research it, we look for new options, we implement it and I expect that we will continue implementing it. Can it replace an interpreter and translator? Maybe in a distant future. We're not there yet. Just like I wouldn't believe and I wouldn't want Google translate or LLM, chat, GPT, et cetera, do my diagnosis. If I go to a doctor, same way I don't want it to interpret for me or translate and have that role output be out there. That would be my parallel. But at linguist education online, every conference that we have, we talk about AI a lot and there are a lot of different opinions on the topic and some are afraid of it, some embrace it. But I think the reality is that interpreters and translators need to understand it and embrace it because it's not going anywhere and they can be replaced by another interpreter and translator who does use technology in the smart way. - Correct, Natalia? - Well, I have a couple of things to bring us to our audience's attention. The first thing is that in medical fields, there are a lot of regulations and laws and so that would be the one thing that will preclude AI to be replacing human interpreters because ultimately healthcare, as you said, is very known for litigation. So who is accountable? You're not going to hold an app or Apple, Google, meta accountable for misinterpreting something in that particular moment, right? So for that very reason and of course seeing what is done in the European Union with the regulations that they think I'm thinking US will follow that and in medical, it will always be stricter than any other industry. So if you're thinking from the perspective on AI developer, it's cheaper for them to go somewhere else. Tourism, all other things then to dab in medical, right? The other thing is oftentimes we're forgetting the thing that we think interpreting is two-directional, right? Or three-directional, depending on how many people you have. Software engineers sometimes think interpreting is unidirectional and that could be used in healthcare, right? If you pre-record some messages in English and then have the opportunity to, you know, automated, you know, provide automation interpreting and 350 languages and at some point somebody human will review those absolutely, right? And that could be announcement, fire in the building, right? Evacuate or shooter, unfortunately, for our country, shooter in the building, right? So those unidirectional things are also technical, it could be called interpreting, but that's not what we talk about interpreting today when we involve a conversation. So that's where I see there could be a use of AI but as far as the regular appointment, we're not going to go there. I think even in 50 years, because too much is at stake here. No doctor wants to lose their license because of misinterpretation. And if AI hallucinates, who says that the term that they would suggest is a correct translation is actually correct, right? You know, I asked you, Judge GPT, can you provide me this source for this translation of this word? I said, well, I am just an automated app, I cannot provide you this source. Or if you cannot provide me this source and I need to do what? Go back and search and see whether that's the correct translation of that word or not. So yeah, I definitely, and of course for CCH, I would do not use AI because we do want to own our exams and right now if something is not created by a human, it's not copyright. Excellent. Well, thank you so much, ladies. I really appreciate it. We're coming up to the end of our conversation. I wish we had a little bit more time. There are a few other topics I would like to cover with you, but maybe you will wait for another session. You're always welcome. This channel is your channel. And for the audience, I want to thank you so much for joining me today. Natalia, Jeanne, and Mila, and Erisa, any last comments before I stop the recording? Go ahead, Natalia. OK, I want to say that if you want to become an interpreter, don't hesitate, become an interpreter. Start learning, start training, and then get certified because that would distinguish you as a human professional that is valid above anything. Thank you, Natalia. Jeanne? Leo, our 10th conference is coming up on December 5th and 6th. We'd love to invite everybody to join. We'll have fascinating discussions for two days. And we'll be talking about AI, for sure. Thank you, Jeanne, Erisa. OK, so I'm going to go a little bit of the industry. And I just read an article that says that if we want to end the polarization worldwide, not just in the United States, we have to think like an interpreter. And I love it because we think two different cultures, two different languages. We communicate what is the right term, what is the right meaning. So I think that being an interpreter not only saves lives in health care, but also helps connect. And connection is what we're missing right now. So being an interpreter is worth it. Thank you, Erisa. I want to add that just like in every profession, there is a shortage of qualified interpreters. Nationally today, there is a shortage of qualified interpreters. So please continue with your journey of professionalization. And we want to see more interpreters entering the profession. We too have very interesting training coming up on October 18th. It's a full day training. It's part of our wellness connection multi-year series. It's empowerment through connection of the role of external regulators in trauma integration. So not only interpreters interpret showing the complexity of our work, but also act as external regulators. And that would be a very interesting topic for those who work with mental health. Well, thank you ladies again one more time. Thanks to the audience for attending or for listening in, we're viewing this episode, episode number 78. From me and the audience to the panel, thank you so much for your participation today. Really appreciate it. And thank you for insights, for your input. And I've learned a lot. And I'm hoping that our audience learned a lot as well. And that's my second time talking to you. I feel like I am learning something new every time I talk to you. So it's great to have you on the channel again. Me and on my behalf, on behalf of the audience, thanks again for the part of this conversation. Don't go anywhere, stay online. I'm going to stop the recording right now. Thank you so much. (gentle music) (gentle music) (gentle music) (gentle music)