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.

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?

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.

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.

Accent Trainers: No Longer Just for Hollywood Professionals

Hollywood? Broadway? Ann Arbor, MI? Where do you find a real Accent trainer? It used to be, only five short years ago, that an accent expert was someone who trained actors and actresses how to speak with a foreign accent for a specific role. Think Tom Hanks in Forest Gump, Kevin Kline in French Kiss, or Jeff Bridges in Crazy Heart. And of course, who could possibly forget the scene in The Pink Panther where the accent trainer was trying to teach Steve Martin how to say ‘hamburger’ with an American accent?

But these days, when someone uses the terms “accent trainer” or “accent coach,” an altogether different set of expertise comes to mind…at least for those of us in the world of corporate, multicultural diversity training. The terms no longer conjure up visions of a movie star being prepped for his or her role in an upcoming blockbuster. Nowadays, the image is often one of foreign-born business professionals wanting to learn English pronunciation in order to convey–not a set of scripted lines–but technical and professional expertise in the real world of team building and good client service. In conference rooms and training offices around the globe, an accent trainer refers to someone creating inclusiveness in our business environments by eliminating language barriers in our diverse, global workforce.

What do an accent trainer in Hollywood and, say, Ann Arbor, MI have in common? If we scratch below the surface, a whole lot! While those working in the film industry tend to think of this line of work as ‘adding an accent’, people, quite mistakenly, think of corporate accent trainers as ‘taking away’ a person’s accent. Not so. At least not at the Accent Reduction Institute. As I’ve talked about in previous blogs, ‘accent reduction’ is a deceiving misnomer for our line of work. Both kinds of accent trainers mentioned above enable people to pronounce sounds that exist in a target language that don’t occur in his/her first language. A highly proficient accent trainer –a true expert- will teach people how to go from one accent to another.

At the Accent Reduction Institute, we call this code-switching, and it’s an integral part of our curriculum. Why? Because it’s always about giving people a choice of how, where, and when they’d like to express and convey their ideas and expertise. Accent trainers in the film industry and accent trainers for the business world may have two different objectives. But we share one common denominator: we teach people how to speak with clarity, confidence, authenticity, and ease.

The Business Case for Diversity & Inclusion Training & Globalization

I went to a fantastic conference last week sponsored by the Human Resources Association of Greater Detroit and this very topic was addressed by the keynote speaker, Dr. Shirley Davis. Dr Davis is the Chief Diversity Officer of SHRM (Society of Human Resource Management), headquartered in Washington DC. To say she’s passionate about creating inclusive environments is an understatement. And she’s passionate about going about it in the most logical way possible: to present the business case. Here are some facts that she shared with us:

  • As our baby-boomers are leaving the workforce, we’ll see a disproportionate number of positions that require highly educated, talented professionals. Many of these workers will be from culturally diverse backgrounds.
  • When workers feel marginalized or under-appreciated, rates of attrition rise. The cost of providing professional development training to a current employee far outweighs the cost of a new hire.
  • Members of our new-immigrant workforce bring to industry unique vantage points. Their innovations and perspectives leads to product development that better reflect the wants and needs of diverse populations…populations with rising purchasing power. According to recent data, as of 2007 the Asian American Market had $400 billion of spendable income; the Hispanic Market had $982 billion.

What does any of this have to do with accent neutralization or accent comprehension training? My thinking goes as follows…

Diversity refers to numbers-increasing the number of personnel from diverse backgrounds. Inclusion refers to getting each constituent of a diverse workforce to work together effectively, productively, and in ways that benefit both the organization and its employees. Communication is a two way street (it takes both a speaker and a listener) and it’s a key determinant of job performance. When we provide accent reduction on one side of the yellow line and accent comprehension on the other, the junctions become ‘roadblock free’. Performance goes up as does an organizations’ bottom line.

So, from an ethical standpoint, is it essential to provide professional development training in order to help every member of our diverse workforce advance? Of course it is. It’s also sound business strategy.

Diversity, Prosperity, and Immigration: Can They Go Hand in Hand?

Have you ever known a time in American history when the topic of immigration wasn’t center stage in the City of Your Choice Times? I certainly haven’t. And this is a good thing. It’s productive and healthy for democratic societies to have ‘national conversations’ that impact us all in unique ways. Like many hot topics, feelings and ideas about immigration and diversity seem to be divided into two diametrically opposed views: either immigration is a powerful tool that contributes to our uniquely American success story or, conversely, we’ve reached a tipping point where immigration is about to do us in and be our kiss of death.

My sense is that, many people on both sides of the equation drive their arguments from an emotional standpoint, as well as sound academic and political research. They either set their gearshift in ‘fear’ mode or ‘touchy-feely’ mode. I’d like to present a few pieces of hard data that may help us sort through the emotional draw and focus on the facts. The following is based on The Global Detroit Study, a research initiative that sheds light on the role and impact foreign-born residents have on one of the most economically depressed regions of our country. The findings reveal why it may be our new immigrants who help move Detroit out of its current state of economic despair and usher it into a new age of prosperity. Key findings of the study show:

  • Immigrants residing in southeast Michigan are 150 percent more likely to possess a college degree than the non-immigrant population (37 percent to 23.7 percent). In addition to being educated, immigrants predominate the science, technology, engineering, and mathematics (STEM) fields that are critical to technologies, innovations, and businesses that power the New Economy jobs and firms. In fact, while the foreign born comprise only 12.5 percent of the U.S. population, they possess half of all new Ph.D.s in engineering; 45 percent of all new Ph.D.s in life sciences, physical sciences, and computer sciences; and 40 percent of all new masters degrees in computer sciences, physical sciences and engineering.
  • The National Venture Capital Association estimates that 25 percent of all public, venture-backed firms launched in the U.S. from 1990-2005 were started by immigrants. These are the most commercially successful of all new economy firms. Similarly, Vivek Wadhwa’s work at Duke University uncovered that 25.3 percent of all high-tech startups in the U.S. from 1995-2005 had at least one immigrant founder.
  • Throughout urban American, immigrants have played a critical role in stabilizing neighborhoods and bringing population growth to central cities that haven’t seen growth since the first half of the Twentieth Century. Immigrant entrepreneurs have shown an innate ability to provide commercial retail services in core city neighborhoods that are in desperate need of jobs, retail offerings, and investment. Ethnic enclaves in central cities are often characterized by lower crime rates, reduction in blight, increasing property values, and new energy.

With the next round of elections about to unfold, the immigration debate will surely get louder and hotter. I’d like to encourage all of us to remember to look at the data when assessing how we can continue to create a prosperous, diverse, and noble America.