Foreign Medical Graduates: Providing Critical, and Quality, Care

For many, the term “talent gap” conjures up an image of rows of empty seats in IT, engineering, and manufacturing. But the talent gap is also felt in healthcare. With the high cost of medical school, and the attractive salaries of physicians that specialize, the U.S. is simply not producing enough physicians to meet demand, especially in primary care.

This shortfall is expected to rise. The Association of American Medical Colleges found that the demand for doctors will continue to outpace supply, leading to a projected shortfall of between 46,100 and 90,400 doctors by 2025, many in primary care. These shortages are compounded by the fact that large numbers of physician ‘baby boomers’ will be retiring in the next few years.

Foreign Medical Graduates (FMG’s) are filling this crucial gap. Today, they comprise nearly 30 percent of all primary care doctors in the United States and provide quality medical care that equals or exceeds that of doctors who graduated from medical schools in the U.S.

Several leading hospitals are embracing the diversity of their medical staff while ensuring seamless communication between FMG’s and their patients. Knowing that pronunciation proficiency is an essential part of communication, these hospitals are providing English pronunciation training for their providers. The results have been transformational: better patient-centered communication due to greater understandability of their physicians, increased physician confidence and engagement, and higher Press Ganey HCAHP patient survey scores.

With a fully empowered physician workforce, these hospitals are filling the talent gap while delivering excellent medical care and the quality experiences their patients demand.

Cool Linguistic Trick to Boost Your Investment Earnings

Who would’ve thought that learning a second language could help in making better business decisions?  According to Boaz Keysar and his team of scientists at the University of Chicago, new research shows that bilingualism, literally, pays off.  Through a series of experiments, Keysar’s team conducted a cross-cultural comparison, recreating six experiments on three continents in five different languages (English, Korean, French, Spanish and Japanese).  In each experiment, test subjects were asked to choose between two options.  The options measured the degree to which a person was risk-averse to loss.  In one test, subjects demonstrated they were risk averse to loss (makes sense…who wants to lose?) and in the other test, they showed they were, surprisingly, risk averse to gain.  Interestingly, people were risk averse to gain when they were presented with scenarios presented in their first language, and risk averse to loss when the same scenarios were given in their second language.  Intuitively, we’d expect the exact opposite.   Why the flip-flop?  According to Boaz and his team, speaking in a second language requires more emotional distance than speaking in a native tongue.  Test subjects were able to think bias-free.

As if this isn’t enough, there are additional perks to bilingualism; one of them being that bilingualism confers protection against the onset of Alzheimer’s disease.   According to the National Institute of Health, bilingual patients are diagnosed with Alzheimer’s 4.3 years later and report the onset of symptoms 5.1 years later than monolingual patients. On the other side of the age spectrum, bilingualism also seems to help young children master higher levels of self-control and better understand abstract rules than their monolingual peers.

Greater chances for financial gain, delayed symptoms of Alzheimer’s, and kids with greater self-control…a veritable Three-For-One.  Not bad!

For those who’d like to learn another language, and who happen to work in a multinational organization, I’d like to suggest a good starting place.  Begin by learning to say “thank you” in each language spoken in your workplace. The benefits far outweigh the time commitment needed to do so.  There’s simply nothing like hearing someone say “thank you” in your own language.  It helps create a personal relationship that facilitates more open communication.  (For a complete list of how to say ‘thank you’ in foreign languages, see: www.omniglot.com/language/phrases/thankyou.htm.)  Mastering this simple phrase demonstrates you’ve made the effort to learn something about your colleague/client.  It shows you’re taking responsibility for part of the communication process.  A priceless message.

Tearing Down the Bamboo Ceiling

I had a wake-up call last week while attending the Conference Board’s 2012 Corporate Diversity and Inclusion Conference in Chicago.  The two day event included informative sessions led by nearly every contingent of the American workforce.  Except one.  The Asian voice was missing.  I couldn’t figure out why, and I couldn’t let the question go.

As I started looking for answers, I began to think there was probably some connection with the fact that, sadly, Asians make up roughly 20% of the workforce but hold less than 2% of executive jobs at Fortune 500 companies.  And, according to the Alliance for Board Diversity Census, Asians hold just 2.1% of all Board seats in Fortune 500 companies.

This phenomenon, known as The Bamboo Ceiling, is part of a national dialogue being discussed in Fortune Magazine, Crain’s New York, The Atlantic, and numerous other publications.  The consensus seems to be that the numbers above are partly due to a cultural discomfort with, essentially, “tooting one’s own horn.”   While the absence of “voicing” one’s accomplishments may be typical in the Asian workplace, it’s the complete antithesis of what’s expected of rising stars in corporate America.

As consultant Jane Chang of Global Novations put it,

“Asian-Americans don’t grow up promoting ourselves; our parents do that for us. Most of us are uncomfortable with the idea of marketing and pitching our work, let alone building a network or having internal champions, common strategies for career advancement. We’ve been brought up with the ethics of keep your head down, work hard, and you will make money….We are not accustomed to speaking up. Thus, we are seen as lacking leadership skills – we can’t lead if we don’t offer our opinions.”

Jane Hyun, author of the book, Breaking the Bamboo Ceiling: Career Strategies for Asians” sums it up nicely by comparing two common idioms.  The first is the Chinese expression, ‘The loudest duck gets shot’; the second is the American saying, ‘The squeaky wheel gets the grease.’

Accent challenges compound this problem.  It makes sense.  Being constantly asked to repeat oneself is hardly incentive for demonstrating leadership skills like being outgoing and engaging in healthy conflict.

There are, however, helpful tools for acquiring the skills needed to “speak up” in ways that leadership takes note of and rewards.  One, of course, is participating in an accent neutralization professional development program.  The other is participating in a local Toast Masters (or similar such) organization.  Many corporations have in-house chapters and some are designed specifically for non-native English speakers.  A little bit of constructive coaching goes a very long way.

ARI’s objective is to help non-native English speakers “speak up” with clarity and confidence.  The only way to reap the benefits of an inclusive environment is to tear down the bamboo, and every other, ceiling.  How else can we see those rising stars shine?

Dictators Promote Understanding

It’s been almost seven years since I received our first inquiry from the American Association of Medical Transcriptionists (AAMT).  These are the folks who listen to dictations by physicians and nurses (who, I came to learn, are fondly referred to as ‘dictators’).  They then transcribe the audio dictations to written format.

The AAMT had a problem and they wanted to know if the Accent Reduction Institute could help.  With nearly 35% of our U.S. practicing physicians being non-native English speakers, understanding some of the dictations could be quite a challenge.  A medical transcriptionist (MT) could hit ‘rewind’ repeatedly, but without an actual process for deciphering unfamiliar speech patterns, they’d be stuck.  The MT’s compared it to the well known analogy of rocking in a rocking chair.  It gives you something to do, but you don’t get anywhere.

Thus, accent comprehension was born.

Last week I provided our process for understanding accented speech to an organization whose workforce comes from all around the globe.  Afterwards, one of the attendees sent me the following note.

My name is Kathleen and my father was a second generation American of Polish descent, his parents only spoke Polish and he only went up to the 6th grade.  He could not pronounce the “th” in Kathleen – he always called me Katleen. Now I understand why.  It is worth it just to have that understanding.  I have to confess that when people would use the term “dumb Polak” I thought they were referring to my father because he did not know how to pronounce my name.

I gasped when I read this.  Very painful.  The prejudicial slur is intolerable; the misunderstanding it created is heartbreaking.  BTW, my grandmother is also of Polish descent, and the immigrant experience in America is both a personal and professional one for me.  Perhaps this is one reason why helping people find their voice has been my lifelong passion.

When the AAMT made that first call nearly seven years ago, I’m not sure they meant to have such a far reaching impact on people’s personal lives.  To this day, I’m grateful for that call.

Talent Gap. Who, Us?

That’s right. We have a talent gap in this country, and many people don’t even realize it. The definition of a talent gap, also known as a skills gap, is where there are more jobs than qualified people to fill them. It may not be obvious to everyone, but the United States talent gap is real, big, and getting bigger by the moment.

Where are the jobs? If I travel around the state (in my case, Michigan), I don’t see a whole lot of “Hiring” signs. That’s because the talent gap isn’t in manufacturing or services. It’s in the STEM fields (Science, Technology, Engineering, and Math).

According to a recent Manpower survey, only 73% of senior human resource managers said they felt their company had the talent it needed to implement its business strategy. And oh by the way, the U.S. Bureau of Labor and Statistics say that between 2006-2016, the STEM fields represent the industries that are growing the fastest. Yikes!

One of the biggest reasons for the disconnect between available jobs and qualified workers is that, for the first time in history, it’s not looking likely the number of workers entering the U.S. labor force will replace the skills soon to be leaving. Baby boomers, who are en route to retirement, account for more than 50% of our current workforce and 25% of workers with STEM degrees. That leaves a lot of soon to be empty seats in fields that are key to company growth and global competition. In fact, the Department of Homeland Security recognizes this as such a serious problem, they’ve created a complete list of DHS, STEM designated degree programs (PDF, 110k).

But not to worry! There’s no need for alarm bells. The seats will in fact be filled by qualified, hard working, well-educated and talented individuals. The difference, however, between tomorrow’s company landscape and yesteryears’, is that many of our co-workers will be foreign born… and non-native English speakers. Today, international PhD students make up 43% of fellow PhD’s in math, 46% in computer sciences, and 51% in engineering. Many of these students would like to stay and, like generations of immigrants before them, contribute to the economic growth and rich cultural fabric of the U.S. workforce.

This leaves a potential challenge for corporate leadership. With people for whom English is a second language, there’s a risk of ineffective communication and alienation, a recipe for “talent disengagement”. Thankfully, this is avoidable. Here are a few techniques everyone can put into practice that make a huge difference in improving collaboration, camaraderie, and productivity:

  • When a co-worker apologizes to you for their “bad English”, tell them: “Your English isn’t bad. You should hear my Chinese, Thai, Spanish, Hindi, fill in the blank!”
  • Learn how to say “thank you” in each of the languages your co-workers speak, and say it!
  • Be patient. English pronunciation isn’t intuitive. Instead of saying, “What? What did you say?” Try, “Could you repeat that for me. I didn’t understand, and I’d like to.”

These short and sweet techniques go a long way in extending the proverbial handshake. It will make the new business climate a warmer one!

Talent Management and the Meta-Message

For those of us who work closely with Talent Managers and Directors of Learning and Development, we need little convincing of the business case for communication training. It makes perfect sense that effective communication is directly proportional to innovation and “mind-share”. In other words, the better we communicate the greater the productivity. And innovation, mind-share, and productivity are the signatures, let’s even call them trademarks, of a free market economy.

While not exclusive to the U.S., Americans can take pride in the “free movement of labor” aspect of its workforce. People are free to move up the ladder not because of social class or familial ties, but because of the unique skill set they bring to an organization and its teams. Talent Managers, Diversity Officers, HR specialists, and Learning and Development folks can especially take pride in their role of ensuring the multicultural talent of our diverse workforce has a level playing field.

Why? Because they’re the ones that promote effective communication programs. These give key talent opportunities to share their expertise with ease and confidence, to get buy-in to new ideas, and to lead others in more effective directions. When this happens, key talent can position and reposition themselves where they, and their organizations, can best maximize their contributions. And even better, what happens when our contributions are noted and valued? We move away from thinking about what’s best for me toward thinking about what’s best for the organization. Everybody wins.

This blog post isn’t an attempt to validate the views of economist Adam Smith or his famous, “The Wealth of Nations”. It’s to recognize the hard, and integral, work that people in charge of communication training bring to their organizations. With specific regard to accent modification, they know that behind every, “What? What did you say?” is an unspoken message conveyed between the listener and his/her speaker. Linguists call this ‘the meta-message’. The meta-message has to do with more than just the meaning of words. It has to do with an implicit, though often unintended, statement about the relationship between the two people speaking. Some people think of this as ‘the message behind the message’. With the example, “What? What did you say?”, the meta-message is clear: You, Mr./Ms. speaker, we have a problem because I can’t understand you.

Accent modification is a relatively new kind of professional development training. At the start of the last decade, there were only a handful of us who left academia to bring it to the private sector. During the early years, the corporate leadership who brought us in were downright brave. They had to defend their budget expenditures on a training program that hadn’t yet amassed the number of participants needed to validate, in any meaningful way, an ROI. (We believe the number needs to be above 1,000 participants who’ve either advanced their careers or had a noticeable impact on their organizations.) It was risky, but corporate leadership took a chance on accent modification; they took a chance on us.

I’d like to make a simple statement to the leadership at corporations, universities, and government agencies who betted on us. I hope both the message and the meta-message are one in the same:

Thank you!

A Rose By Any Other Name…

We’re all partial to names. The study of names is called onomastics and, for those of us in the field, it’s a branch of sociolinguistics of great interest, geeky though it may be. Historically speaking, the giving of surnames typically originated from one of four sources: place-names, “descriptive”, trade-names, and names indicating family relationships. Many of these surnames have survived through the centuries and passed the test of time. Place-names which crossed the Atlantic along with their English owners include Lincoln, Brooks, Churchill, and Atwood (“at” means near in Old English). Some common, old-age “descriptive” names are Goodman, Armstrong, White, and Small. Familial names, called patronymics, are found on nearly every corner in most major American cities: Johnson (son of John), Fitspatrick (fitz means “son” in Norman), and MacDonald (mac is “son” in Gaelic).

Trade-names are at the top of my personal ‘surname favorites’ list. This is probably because so many of them are carryovers from now obsolete medieval occupations: Archer, Bowman, Shepherd, and Forrester to name a few. Smith, by the way, is not only the most common surname in America and England, but is also the most common surname in nearly every other European language: Schmidt (German), Ferrier (French), Ferraro (Italian), Herrero (Spanish), Kovacs (Hungarian), and Kusnetzov (Russian).*

Names are important. They’re a central part of our heritage and unique cultural identity. That’s why, as part of ARI‘s corporate diversity and training program, Building Bridges: Tuning Your Ear to Accents, we teach people how to pronounce the names of clients and colleagues for whom English is a second language. Making the effort to say someone’s name correctly speaks volumes (no pun intended)! It says, “I appreciate you, and your culture.”

Here’s some advice on how to accurately pronounce non-English names:

  • Pronounce the letter “a” like “ah” (As in cop)
  • Pronounce the letter “e” like “ay” (As in cape)
  • Pronounce the letter “i” like “eee” (As in keep)
  • Pronounce the letter “o” like “oh” (As in cope)
  • Pronounce the letter “u” like “uw” (As in coop)
  • Pronounce the letter “s” like “s” (not z) (As in so)
  • Pronounce the letters “Zh” like “si” (As in the word illusion)
  • Pronounce the letters “Xi” like “sh” (As in the word shoe)

Now using the key above, try pronouncing the following names. Pay particular attention to the underlined letters, substituting the more authentic pronunciation (as above) for its American accent equivalent: Oscar, Susanna, Alex, Zhang, Xin, Isabella, and Shrinivas. Isn’t that so much easier?

If you have a good “name” anecdote to share…maybe you’ve also driven through Hell, MI or Wahoo, West Virginia, please let us know. We’d love to hear your stories!

*Bill Bryson, The Mother Tongue

Global Trends: Focusing the Lens of Communication Training

If I were ‘fluent’ in a foreign language, most people would take it to mean that I’d mastered the grammar, vocabulary, reading, writing, and pronunciation rules of that language. I’d like to suggest another aspect of language proficiency that isn’t typically included, one that deals with the relationship between language and culture.

Linguists call this often neglected, but absolutely essential, part of speech, ‘phatic’ communication. This is the area of discourse that has nothing to do with requesting information (interrogatives), or telling someone what to do (imperatives), or giving new information (declaratives). ‘Phatic’ communication falls into a more elusive category… the realm of using language to build, maintain, and negotiate relationships. Expressions like “thank you,” “I’m sorry,” “you’re welcome,” and “please” are all examples of ‘phatic’ communication.

In our multicultural workforce, sometimes the intent of our message gets lost in translation. For example, when we use idiomatic expressions that mean, “you’re welcome,” we may lose the sense of gratitude. “You’re welcome” sounds sincere and appreciative. Can’t you just feel the sincerity in the phrase? Yet other phatic expressions – “don’t worry about it,” “not a problem,” “no big deal,” “just trying to be helpful,” “it was nothing” -hardly do justice to a good ol’ fashioned “you’re welcome.”

The American workforce, with its international supply chain, is becoming more and more diverse. Corporate training now reflects an unprecedented focus on communication training programs. And language skills are now rightly viewed as being either “enablers” or “disablers.” Language can facilitate collaboration and innovation, or isolation and stagnation.

We know that the top Fortune 100 companies are also the organizations with the strongest diversity and inclusion programs. My goal is to help companies leverage the connection between language and culture to increase productivity, mind-share, and the bottom line.

One way we do this is to provide communication training programs that get people thinking about word choice. When we speak, what do we convey in addition to basic information? What is the message behind the message? Is it ‘you’re welcome’ or ‘no problem’? To a non-native English speaker, the phrases may suggest two very different sentiments. Practice English, whether it’s your first language or second, using ‘phatic’ speech that conveys the very best of your intentions. Use language to create bridges of communication.

Communicating Joy: An ROI to Accent Modification Training

The Accent Reduction Institute’s mission statement is a little deceiving. It states, Eliminating Language Barriers While Helping People Maintain Their Unique Cultural Identity. While this certainly isn’t untrue, it doesn’t tell the whole story. Our “M.O.” is actually bigger than it may appear: bring joy to our clients, joy to their organizations, joy to their clients, and joy to our faculty and curriculum writers. That’s our goal. Our objective. Our end all, be all. To borrow from the French…creating joy is our raison d’etre.

Why all the fuss about something as touchy-feely as “joy”? Wouldn’t it be more reasonable to expect an American accent training company‘s objective to be more along the lines of…helping people be more productive? Or giving people the tools they need to better communicate their professional expertise to colleagues and clients? Or enabling our international workforce to raise the bottom line of their companies? Of course! But these objectives are the logical consequences of what we do (accent modification), not why we do it.

Our mission statement speaks to our more fundamental goal of helping people fully participate in their own lives. Most of our program participants sought training because they were frustrated by the constant question, “What? What did you say? Can you repeat that? I don’t understand what you’re saying.” By the time they found us, they’d already shut down a part of themselves.

If you had two proposals in front of you, one from a company whose employees held back from full participation and one whose employees were eager to jump in and joyously innovate, problem solve, and assist…which company would you choose? Perhaps the companies that hire us may even say that Joy is their ultimate ROI as well…after their personnel complete pronunciation training these companies get, and retain, customers who appreciate working with them.

I recently asked our Director of Curriculum and Training, Barb Niemann, about the highlight of her year. Barb’s answer? “Our participants can now speak English without a language barrier. They’re happy. Their managers are happy. Their clients are happy. I’m thrilled.”

Cultural Competency: Creating Collaboration

ARI faculty provide communication training for a wide variety of organizations: those in corporate America, academia, the US Department of Defense, non-profit community agencies, etc. And, without exception, there’s an emphasis on a new area of proficiency that reflects the diversity of our current task/workforces: cultural competency.

What in the world is that? What does it mean to be culturally competent? In pursuit of an answer, I’ve found that while the specifics change from organization to organization, the phrase always includes a common objective: understanding the culture of those with whom we work and serve in order to create partnership and collaboration.

There are all kinds of ways to become culturally competent:

  • We can learn business protocols, dining etiquette, and greeting and leave-taking customs.
  • We can learn about religious perspectives and historical experiences that shape views of family, community, and team building.
  • We can also learn how language reflects people’s views of culture and their place in it. If language is the vehicle that conveys information, culture is the lens we use to interpret it.

Being culturally competent means knowing how to speak in ways that go beyond simply exchanging information; it means using language to build successful relationships. How can we demonstrate cultural competency in our diverse workplaces? A good starting point is to hit ‘delete’ on that one phrase we habitually use when we don’t understand someone’s accent: “What? What did you say?” While ill-will is certainly not intended, often this phrase does more harm than good. The message behind the message, the meta-message, is, “I don’t understand because you have a problem speaking.” Not helpful for establishing goodwill and camaraderie. Instead of “what did you say”, try, “I’m sorry. I didn’t understand. Could you please repeat that for me?” The meta-message is altogether different.