Paying Residents Who Speak Spanish More $

[DermpathMD]

FYI - My cousin is a resident at Parkland Hospital in Dallas. He says the hospital has a policy of paying residents who can speak Spanish an extra $1200 per year. It is called the Spanish Language Incentive Pay Program.
http://www.parklandcareers.com/content.asp?c=ben

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Members don't see this ad.

 

[TysonCook]

same at our hospital, the downside is that you can be used to translate for others, i.e. if an interpreter is busy...guess what...the RN is grabbing you

 

[tr]

Hey, really? That's super! I never got jack for speaking Spanish, except for saving my own time by not having to call an interpreter (and sometimes I get pulled to translate on other people's patients anyway).

There was a piece in the NYT Health section (with an accompanying Well blog post) recently about language barriers in patient care.

http://www.nytimes.com/2009/04/23/health/23chen.html

http://well.blogs.nytimes.com/2009/04/23/doctoring-in-a-foreign-language/

One of the commenters said there should be more incentives and rewards for med students/residents who speak other languages, and I totally agree with that. I didn't see that anybody was ever very interested on the interview trail, but actually Spanish has been way more helpful than a lot of other random CV-fillers that admissions committees seem to care about.

 

[McGillGrad]

That's a great idea. It's always a good idea to encourage learning languages.

Now if they could just pay me to speak French and German, too.

 

[slight365]

I'm for more people speaking different languages and getting paid for it.

Hell, I speak German fluently, and have medical German in addition to English medical terminology, so I'm hoping it will fit somewhere.

 

[McGillGrad]

I'm for more people speaking different languages and getting paid for it.

Hell, I speak German fluently, and have medical German in addition to English medical terminology, so I'm hoping it will fit somewhere.

Pennsylvania and Montana I would guess, lol...

 

[Hurricane]

One of the commenters said there should be more incentives and rewards for med students/residents who speak other languages, and I totally agree with that. I didn't see that anybody was ever very interested on the interview trail, but actually Spanish has been way more helpful than a lot of other random CV-fillers that admissions committees seem to care about.

Not only does Parkland pay you more, but residency applicants get bonus points in our scoring system for being fluent in Spanish.

 

[DeLaughterDO]

Not only does Parkland pay you more, but residency applicants get bonus points in our scoring system for being fluent in Spanish.

While I'm all for globalization and world economy and what-not, how about we encourage people in the USA to speak the same language as everyone else in the USA. It doesn't even have to be English, just choose one and make it standard. Have a national language, and save a crap load of money in the national budget on printing things in 443 different languages and providing interpreters.

Speak what you want in your house or community, but where there is business being done, it all needs to be in the same language.

 

[Cp22kjer]

While I'm all for globalization and world economy and what-not, how about we encourage people in the USA to speak the same language as everyone else in the USA. It doesn't even have to be English, just choose one and make it standard. Have a national language, and save a crap load of money in the national budget on printing things in 443 different languages and providing interpreters.

Speak what you want in your house or community, but where there is business being done, it all needs to be in the same language.

Well said.

 

[DrJosephKim]

Wow, that's almost like rural family medicine centers paying off your school loans! Actually, I think it's a very fair incentive to attract physicians to work in difficult (and not so popular) areas of this country.

 

[NonTradMed]

While I'm all for globalization and world economy and what-not, how about we encourage people in the USA to speak the same language as everyone else in the USA. It doesn't even have to be English, just choose one and make it standard. Have a national language, and save a crap load of money in the national budget on printing things in 443 different languages and providing interpreters.

Speak what you want in your house or community, but where there is business being done, it all needs to be in the same language.

The problem is you can't tell your patients to "go home, learn english, then come back to tell me your problem". Things like healthcare will *always* require interpreters because we need to know what's wrong with them *now*.

Always, keep in mind that the US is constantly getting a influx of immigrants. People who came here may require interpreters initially but then they move beyond the need for it. But then the next batch of people need interpreters for a few years and they move on. Unless immigration is stopped for good, you will always need services for interpreters. Also, older immigrants always feel more comfortable speaking in the language of their youth. I believe in encouraging people to learn English, but as business owners, it's a marketing draw to advertise bilingual skills to attract certain clientele. I am fluent in Chinese and English and I plan on advertising my language skill set when I practice. Sure, it would be nice if all my patients can speak English, but why not take advantage of a skill set if you already got it?

 

[Aesculapius]

This is very cool.

 

[DeLaughterDO]

The problem is you can't tell your patients to "go home, learn english, then come back to tell me your problem". Things like healthcare will *always* require interpreters because we need to know what's wrong with them *now*.

Always, keep in mind that the US is constantly getting a influx of immigrants. People who came here may require interpreters initially but then they move beyond the need for it. But then the next batch of people need interpreters for a few years and they move on. Unless immigration is stopped for good, you will always need services for interpreters. Also, older immigrants always feel more comfortable speaking in the language of their youth. I believe in encouraging people to learn English, but as business owners, it's a marketing draw to advertise bilingual skills to attract certain clientele. I am fluent in Chinese and English and I plan on advertising my language skill set when I practice. Sure, it would be nice if all my patients can speak English, but why not take advantage of a skill set if you already got it?

Having grown up in Texas, I know several families whose matriarchs and patriarch have been in the States for DECADES and still speak absolutely no English. Usually, in these instances, the second generation is fluent in English, because they learn it in school, but there is no real incentive for people to learn English because we, as a society, are so willing to twist ourselves into pretzels to accommodate.

Until we make it mandatory that everyone participating in ANY business transaction does it in a common language, and we stop making it easy for everyone to get around it by printing all information in dozens of languages, there will be no incentive to learn that common language, whatever it is.

I agree that the United States will always have an influx of new immigrants and it will take time for them to learn the language, however, if we have a national business language, it would not be our responsibility (and hence, our cost) to provide interpreters, saving the taxpayers millions, if not billions of dollars a year (these numbers are conjecture only, I have no idea what the savings might actually be).

I'm not arguing that we each should learn a second, or maybe even a third language, and that having knowledge of different languages and offering that service to your patients may be noble and may gain you patients that I will not get, but I do not agree that I should bear more of the cost of medical care for patients who do not even bother to try to learn the language.

As emergency physicians, we eat enough of the healthcare costs due to the unfunded mandate, called EMTALA, which costs each Emergency physician approximately 100K per year (on average) in uncompensated care. How much more does society want from me?

 

[efex101]

agreed, if you go to ANY other part of the world, if you do not know their language, there will be NO interpreter for you.

 

[NonTradMed]

Until we make it mandatory that everyone participating in ANY business transaction does it in a common language, and we stop making it easy for everyone to get around it by printing all information in dozens of languages, there will be no incentive to learn that common language, whatever it is.

I agree that the United States will always have an influx of new immigrants and it will take time for them to learn the language, however, if we have a national business language, it would not be our responsibility (and hence, our cost) to provide interpreters, saving the taxpayers millions, if not billions of dollars a year (these numbers are conjecture only, I have no idea what the savings might actually be).

I'm not arguing that we each should learn a second, or maybe even a third language, and that having knowledge of different languages and offering that service to your patients may be noble and may gain you patients that I will not get, but I do not agree that I should bear more of the cost of medical care for patients who do not even bother to try to learn the language.

I think we disagree about the usage of interpreters here. I see it as a temporary gap measure to help newly arrived immigrants, and you see it as a device that enables immigrants to resist learning news languages.

It's only a matter of degree that can turn the former into the latter.

While I agree that learning English is very important, I'm not sure how one goes about requiring business transactions to be done in English only.

Why should the government dictate to me what language I should use in my own clinic? Why should a grocery store be told they can't advertise in another language? Heck, why should a Chinese restaurant not be able to provide me with a Chinese menu given that, despite my 95th percentile on the MCAT verbal, I still don't know any of the Chinese dishes by their English names?

I think private businesses should be left alone to do whatever they want, but government businesses should utilize mostly English with exceptions made for law enforcement, hospitals, safety regulators, certain schools information and abuse shelters.

agreed, if you go to ANY other part of the world, if you do not know their language, there will be NO interpreter for you.

Actually, if you go to other parts of the world, they will more likely be able to speak more than one language, and probably English as well.

 

[slight365]

I have not yet seen the scenario of a tourist needing to obtain emergency health care. I have seen the default going towards immigrants in this thread.

 

[DeLaughterDO]

I think we disagree about the usage of interpreters here. I see it as a temporary gap measure to help newly arrived immigrants, and you see it as a device that enables immigrants to resist learning news languages.

It's only a matter of degree that can turn the former into the latter.

unfortunately, I don't think there is a way to have interpreters universally available and not encourage people to not learn the common language

While I agree that learning English is very important, I'm not sure how one goes about requiring business transactions to be done in English only.

Easy. Pass a law that all business transactions are done in xyz language. Stop printing all official communications and broadcasting in languages other than xyz. It's done.

Why should the government dictate to me what language I should use in my own clinic? Why should a grocery store be told they can't advertise in another language? Heck, why should a Chinese restaurant not be able to provide me with a Chinese menu given that, despite my 95th percentile on the MCAT verbal, I still don't know any of the Chinese dishes by their English names?

If you want to offer a different language in your clinic, or if a business wants to advertise or conduct business in a language other than xyz language, they are free to do so. However, all must be capable of conducting business in xyz language. Any other languages will be "value added" services. This way, there is a common language in which EVERYONE can communicate, eliminating the cost to the taxpayer to provide an interpreter for every known language in the world, just in case it might be needed.

I think private businesses should be left alone to do whatever they want, but government businesses should utilize mostly English with exceptions made for law enforcement, hospitals, safety regulators, certain schools information and abuse shelters.

I guess we'll just have to agree to disagree then.

Actually, if you go to other parts of the world, they will more likely be able to speak more than one language, and probably English as well.

There are parts of this country where I can go and not find a single English speaker within a city block. And your point is not valid to this argument. If you go to France, while many of the French may speak perfectly fluent English, if they learn you are American (i.e. from the US), many will only speak French to you, just because many of them despite Americans, right or wrong.

There is no law in any other country (of which I am aware) mandating that all government or public publications must be in more than one language (the native language), or that a business (i.e. a hospital) or the government (i.e. the taxpayer, in the case of government run/owned buildings) must bear the brunt of the cost of hiring an interpreter for a non-native-language speaker. Maybe I am wrong.

 

[DeLaughterDO]

I have not yet seen the scenario of a tourist needing to obtain emergency health care. I have seen the default going towards immigrants in this thread.

Unfortunately (or maybe fortunately for this argument), I do not live in a high-tourist location, so I cannot comment from personal experience. However, if a person were vacationing in a place where they did not speak the language (i.e. if I were visiting Greece, or any of the hundreds of countries where I do not speak the language), would they pay for me to have an interpreter if I were to need medical care while in their jurisdiction? If not, then why should I (the taxpayer) pay for someone not of this country to have an interpreter if they are to need one?

The most probable situation goes as such: if I were to travel abroad, need medical care, and not speak the language, one of a very few things would happen.
1. I would have someone with me who could translate, because I would not be stupid enough to go to a foreign country where I did not speak the language without someone who natively speaks the language, or at least fluently enough to get around.
2. In the case that my friend (or hired interpreter, if that is who I have in scenario #1) is killed/incapacitated in the accident that causes me to need medical care (or is otherwise unavailable for whatever reason), perhaps someone at the medical facility to which I present would speak my language and be available to translate, most likely at my expense for their services.
3. Someone would be hired by the hospital on my behalf to translate (i.e. language line, etc), the cost of which would most likely be passed on to me through my bill.
4. Noone would be available and I would get less than optimal care and possibly die.

Note, this would all be avoided if either I spoke the native language or had someone with me to translate, with no added cost to the hospital or their society in general.

Now, #2 or #3 would work in this country, in a limited capacity, if hospitals and physicians could pass the cost of interpreters on to the patient or patient's insurance. The cold hard truth is, however, that we cannot. Our payments are decided based on DRGs and services rendered, not on an itemized basis. If an insurance carrier (or medicare/medicaid) decides they are going to pay xxx amount, that xxx amount must cover all required services for that diagnosis. Interpreting services are not included in this number, believe you me.

To top it all off, California has now outlawed Balanced billing (appeals pending), which means that physicians and hospitals cannot bill the patient directly for any part of their bill their insurance carrier decides not to cover. We just have to be happy with whatever bit of chump change they decide to offer us. Again, declining payments do not encourage offering more services that have to come out of our pockets.

Long post to say one thing: if you travel abroad (or move to a country where you do not speak the language), it should not be the responsibility of the society in which you now reside to offer you services. You should pony up and bring those services to the table yourself or be prepared to pay for them when that society has to obtain them for you.

 

[RustedFox]

Agree with DeLaughterDo:

People all too often like to champion the healthcare systems of "country X" because "everyone has access to care there and it WORKS for them; if only we would pay attention and learn!"... but what they fail to realize is that not only is the USA is a a nation several times larger and more difficult to manage, but also is under some sort of bizarre moral/ethical obligation to treat at no/greatly reduced cost every immigrant that happens to be "passing through" for a couple of decades. You don't see people flocking to the UK/Italy/Germany/France for their medical needs, and those respective governments are certainly not interested in picking up the tab for that person's very preventable complication that would not have occured if they would have only been compliant with their HTN/DM meds or antibiotics instead of looking for the "quick fix now" and forgetting all about taking care of their own health in the long-term as so-often happens here.

There's an adage that goes; "When in Rome, do as the Romans do."

Everyone likes to say that, and everyone agrees that its a good idea to observe the cultural laws/mores/customs of whatever nation that they're in at the time. Why does nobody think that this applies to the USA as well? Are we not good enough? We need to stop bending over backwards for everyone else and stand up for ourselves.

 

[tr]

Are you guys serious? We are "bending over backwards" to accommodate people who don't speak the language?

Americans are less likely than citizens of any other developed nation to speak a second language.

if a person were vacationing in a place where they did not speak the language (i.e. if I were visiting Greece, or any of the hundreds of countries where I do not speak the language), would they pay for me to have an interpreter if I were to need medical care while in their jurisdiction?

Actually, far and away the most likely outcome (esp in a developed nation) is that somebody there - probably the doctor - would speak English.

Funny you should mention Greece, because I happen to be fluent in Greek and I would wager there is not a single doctor in the whole country who is not sufficiently competent in English to communicate any necessary medical information to an English-speaking tourist. Educated people in Greece learn English (and usually at least one or two other languages as well, typically French, German, or Italian).

Why should not educated people in the US learn other languages? For some reason we don't start our foreign language education here until high school, after the developmental window for language acquisition has closed. That's the dumbest move ever. Kids in Greece start learning English in first grade. By the time they're out of high school they can actually speak it, unlike your typical student in the US who can maybe fumble his way through a scripted conversation about birthdays or grocery shopping after completing his 'foreign language requirement' with 2-3 years of high school Spanish.

Btw I agree that patients or their insurance companies should be billed for the costs of interpeters, instead of making the dr or hospital eat them... but that's a different angle. Nobody has to pay the cost of an interpreter if the doc and patient share a language. Hence the best solution is for everyone to learn more languages, rather than bickering over who pays the interpreter.

 

[DeLaughterDO]

Are you guys serious? We are "bending over backwards" to accommodate people who don't speak the language?

I would argue that we are, in fact, bending over to accommodate those who do not speak English in this country. In how many other countries are all official publications not only in one, but potentially in any of the over 300 languages spoken in the US? Because of executive order 13166, any person can demand that any business that receives money from the government (including hospitals and physician's offices) must provide them with a translator, if they so desire it. Also, all publications must be available in any language. There have been several lawsuits surrounding this issue, just google it and you'll find plenty. I call that twisting myself into a pretzel, especially since I have to bear the cost of it.

Americans are less likely than citizens of any other developed nation to speak a second language.



Actually, far and away the most likely outcome (esp in a developed nation) is that somebody there - probably the doctor - would speak English.

Funny you should mention Greece, because I happen to be fluent in Greek and I would wager there is not a single doctor in the whole country who is not sufficiently competent in English to communicate any necessary medical information to an English-speaking tourist. Educated people in Greece learn English (and usually at least one or two other languages as well, typically French, German, or Italian).

Why should not educated people in the US learn other languages? For some reason we don't start our foreign language education here until high school, after the developmental window for language acquisition has closed. That's the dumbest move ever. Kids in Greece start learning English in first grade. By the time they're out of high school they can actually speak it, unlike your typical student in the US who can maybe fumble his way through a scripted conversation about birthdays or grocery shopping after completing his 'foreign language requirement' with 2-3 years of high school Spanish.

Btw I agree that patients or their insurance companies should be billed for the costs of interpeters, instead of making the dr or hospital eat them... but that's a different angle. Nobody has to pay the cost of an interpreter if the doc and patient share a language. Hence the best solution is for everyone to learn more languages, rather than bickering over who pays the interpreter.

The point isn't whether everyone should learn more languages - which I wholeheartedly agree with, the argument here is whether hospitals (or physician's offices) should be forced to provide interpreters for those who do not speak the common language of a society.

Don't get me started on the education system in this country, or the students who (in)frequent it...

What if I only spoke Vietnamese and I were in Greece? What then? Should I expect them to have someone who speaks my language? Should every business in every country have at least one person who speaks every language on the planet? This isn't about English, French, Greek, or any other language. It is about the unrealistic burdens placed on society by not speaking the language of the majority in the area in which you live.

 

[NonTradMed]

Easy. Pass a law that all business transactions are done in xyz language. Stop printing all official communications and broadcasting in languages other than xyz. It's done.

This wouldn't work when there's urgent messages that need to be disseminated, or when public welfare is at stake.

At my medical school, we have a county hospital and many people there are immigrants. It's incredibly difficult to explain medical procedures and medical terms to someone who speaks only broken English.

So our hospital could either guess what the patient has based on universal sign language of 'yes' and 'no' head nods, get the patient's five year old kid to translate, or (one is available), get a translator who is trained in medical Spanish. And this degree of communication can be very important during times of disease outbreaks like swine flu.

From your post, you seem to suggest we have to either print everything in every language imaginable or require everyone to do English only for everything.

But why does it have to be one extreme or another? For urgent services such as law enforcement, health care etc we should still print translations and have interpreters available, and use them judiciously. Only for emergencies or when public information needs to get out quickly. For non-emergent cases, we can do English-only. This way, we encourage people to learn the language without jeopardizing public welfare.

Interestingly enough, my state has an English-only law, yet our county hospital still provides for interpreters because they make exceptions when public welfare is involved.

There are parts of this country where I can go and not find a single English speaker within a city block. <snip>

I'm not sure what point you thought I was making. My comment was made tongue-in-cheek. Rough week?

There is no law in any other country (of which I am aware) mandating that all government or public publications must be in more than one language (the native language), or that a business (i.e. a hospital) or the government (i.e. the taxpayer, in the case of government run/owned buildings) must bear the brunt of the cost of hiring an interpreter for a non-native-language speaker. Maybe I am wrong.

Here's a wiki article on official languages and bilingualism. Some countries actively encourage bilingual languages for various reasons and do official business in more than one language.

In fact, my dad lived in Quebec for a few years and he mentioned that Canada adopts a bilingual approach at the federal level. However, I think only one province adopts bilingualism at the provincial level.

EDIT: Here is the article on Canada's official bilingual policy. At the federal level, it is required that all business be conducted in both French and English and provide government services in both languages.

I'm not advocating turning America bilingual though. I believe a country works best when there is one dominant language. However, given our large immigrant population, I acknowledge a need to ensure certain services (law, health care) needs to be in more than one language to ensure continuing public welfare.

 

[Saladin MD]

Actually, if you go to other parts of the world, they will more likely be able to speak more than one language, and probably English as well.

LOL yeah. haha

You have some *excellent* posts in this thread.

 

[slight365]

In my case, I'm an American in Germany. Unfortunately, I suffered a couple of biking injuries and needed some emergency dental work. While I was able to speak and understand some German, it was not totally understandable due to the level and due to the dialect. While one specialist spoke English, it was more for the purpose of insulting me about what we (Americans) did to everyone with the finance crisis. Another specialist definitely spoke English, but I preferred to speak German. In fact, I have never asked anyone to speak to me in English before they volunteered it, and usually, I continue speaking German.

Another example of multi-lingualism is Switzerland, with four official languages. Somehow it functions, holding 1/3 of the world's total wealth.

Freiburg in Germany is their only official multi-lingual city, speaking French and German officially. On the east, several towns along the German-Polish border are bilingual, including the high schools and universities.

In some respect, every country caters to English speakers, and as someone mentioned above about the French, go there, don't talk about it. I have not had the problem with speaking English there. When one politely apologizes for not speaking their language, you'd be really surprised to see how much they help. Hell, even in the US, I experienced the same. WHen someone didn't speak English, but tried and was apologetic, everything worked out great.

While I advocate single language, it's not practical or realistic, and in the end, we're health care providers and our duty is to provide care any way we can. :eave the language concerns to the representatives, management, insurors, and the patients themselves. In the end, we can only do what we can do and if the language is a constraint, it should preclude someone from giving them the best possible care under those circumstances.

 

[Saladin MD]

^^^ Excellent post, Slight. I also believe that English alone should be the national language. But like you, I believe it is unrealistic and--as health care providers--we have a duty to provide health care no matter what, and with beneficence. We take care of people who OD on cocaine or heroin, people who develop lung cancer from smoking, etc, all of whom are more blameworthy than people who simply can't speak a language. We can't make judgment calls; our profession is too noble for that. We just help. That's it.

Furthermore, I really dislike xenophobic depictions of immigrants, who just "refuse" to learn the language. It's very hard for old people to learn new languages, especially if they have no time in the day. If we able-bodied physicians have a hard time trying to learn another language, then what can we expect of elderly people? Furthermore, it is almost always the case that the F1 generation (i.e. the first generation) does learn English.

There is no law in any other country (of which I am aware) mandating that all government or public publications must be in more than one language (the native language), or that a business (i.e. a hospital) or the government (i.e. the taxpayer, in the case of government run/owned buildings) must bear the brunt of the cost of hiring an interpreter for a non-native-language speaker. Maybe I am wrong.

I don't know if this is true, but if it is, why take away what makes America a great country?

Long post to say one thing: if you travel abroad (or move to a country where you do not speak the language), it should not be the responsibility of the society in which you now reside to offer you services. You should pony up and bring those services to the table yourself or be prepared to pay for them when that society has to obtain them for you.

It is exactly these sort of laws that make America a great place.

"Give me your tired, your poor, your hurdled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me."