Physician-nurse migration to the United States: regional and health status origins in relation to legislation and policy

This article examines the origins of physicians and nurses who were admitted as permanent immigrants to the US from 1962-1979. Data are mainly from the Immigration and Naturalization Service. Countries used in the developmental analysis are only those whose population was estimated at 1 million or more as of mid-1979, encompassing 99% of the physicians and 97% of the nurses. Life expectancy at birth is the criterion used to differentiate origin countries by developmental dimension of health status. During the study period, health workers constituted about 30% of immigrants admitted to the US; of these, nurses and physicians constituted 72-82% throughout the study period. The period 1962-1979 has 4 distinct phases, marked by important legislative and/or policy changes; 1) 1962-1965, when the McCarran-Walter Act prevailed; 2) ending in 1968, the 2nd phase covers the transition mandated under the 1965 Immigration Act, which encouraged physician immigration; 3) the 3rd phase, 1969-1976, covers the transition to the 1976 Immigration and Nationality Act amendments; and 4) the 4th stage is 1977-1979. Results show that 1) under the McCarran-Walter Act, North America became the dominant physician source; 2) from 1966-1968, Asia attained dominance as the physician source and became even more predominant after 1968; 3) North America produced relatively few physicians in the early 1970s; 4) Europe produced substantially fewer physicians in the 1970s than in the 1960s; 5) South America, Africa, and Oceania were the lowest contributors of physicians; 6) during the McCarran-Walter years, North America and Europe produced almost 90% of nurses admitted into the US; 7) the 1965 Immigration Act and its aftermath resulted in Asia becoming the dominant source of nurses; 8) prior to the 1965 Immigration Act, Canada generated 20% of the aggregate number of physicians; 9) the Philippines surpassed Canada during the transition and India led after the transition; and 10) Canada supplied 30% of the nurses up through the transition, with the Philippines in the lead 1969-1979. Low health status countries were a relatively minor nurse source. Health status at the origin was a far less significant determinant of physician immigration than that of nurses. English language high and low health status country groups produced substantially more physician and nurse immigrants that their corresponding non-English language counterparts. The US attracted more physicians and nurses from less developed countries than more developed countries after 1968.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

Update on medications for the treatment of anxiety

It is interesting to note that antidepressants are widely represented in the medications used to treat the anxiety disorders. This has led to speculation about the role of depression, particularly subclinical forms being manifested as anxiety disorders. The specificity of diagnostic categories suggests that, at least for the moment, medications have a very specific and circumscribed role in the treatment of anxiety. This suggests that the difficulties of many anxious patients are not effectively treated with medication or that medication has only a short-term role at best. The next column will review health problems associated with psychotropic treatments for anxiety and discuss strategies for creating a "wedge," ie, introducing adjunct learning experiences along the anxiety gradient in conjunction with pharmacotherapy.     

The employment contract: A test of the transaction cost theory

This paper tests some predictions derived from Williamson's transaction cost theory of the organization of work, which holds that the form of the employment relationship is determined largely by the idiosyncrasy of work—that is, the nature of skills and knowledge used in production. It examines the occurrence of theoretically relevant provisions in collective bargaining agreements in the United States and finds they are related to a contract-level proxy for idiosyncrasy (based on bargaining structure) as predicted by the theory. An analysis of an individual-level variable, the difficulty of finding a comparable job, provides some additional support. Finally, several alternative explanations of the results are considered, and it is argued that none are consistent with the evidence. The analysis thus finds strong, if necessarily provisional, support for the theory.     

Some quantitative concepts of value and utility from a utilitarian point of view

This paper clarifies and interprets some basic quantitative concepts of value, utility and utility function from a utilitarian point of view. First, I discuss the question as to whether value is objective or subjective. I hold that value is subjective and statistical in nature (although from the various subjective values of a certain object a norm can usually be obtained). Second, I emphasize the distinction between use value and exchange value in relation to utility. Third, I propose a law of diminishing incremental interest, which refers to the incremental (marginal) utility of money. Fourth, I identify the utility of money with the von Neumann-Morgenstern utility. Fifth, I question the necessity of the usual normalization of utility functions and the restricted linear transformation (and the consequent concept of strategic equivalence). Sixth, I discuss in detail the terminal values and utilities of a utility function from a philosophical rather than mathematical point of view, particularly the boundedness of a utility function and the magnitudes of V ₀ and U ₀. Finally, I conclude that, in order to be able to have interpersonal comparisons of utility, utility should have the same dimension as value rather than no dimension, and the normalization problem should be reconsidered in the light of terminal values and utilities.     

Chicanas modernize domestic service

The shift from live-in to day work was a step in the modernization of domestic service because it limited the length of the working day and reduced the psychological exploitation involved in the interpersonal relationship between domestics and mistresses. Even the shift to an hourly wage did not end the extraction of emotional labor, however. Interviews with Chicanas employed as private household workers reveal the next step in the evolution of domestic services. The current development is away from wage work, in which labor time is sold, selling a service in which a job is exchanged for a specified amount of money. Chicanas are defining themselves as expert cleaners hired to do general housework. Most supervision and personal services are thus eliminated from the job. Mistress-servant relations are being transformed into customervendor relations, reducing the personalism and asymmetry of employer-employee relationships.An earlier draft of the paper was presented at the 1986 National Association for Chicano Studies, El Paso, Texas. This research was made possible by a grant from the Business and Professional Women's Foundation and a University of California President's Fellowship. I wish to thank Frances Kleinman and Eric Margolis for their helpful comments on this paper     

From making to being the excuse: An analysis of deception and verbal/nonverbal issues

Excuse-making is defined, and the issues of deception and verbal/nonverbal presentations are discussed in regard to the excuse process. Subsequently, the deception and verbal/nonverbal issues are described in greater detail in the context of whether the excuse occurs temporally after a negative outcome (retrospective), before a negative outcome (anticipatory), or as part of the characterological makeup of the person (incorporated). Going from retrospective to anticipatory to incorporated excuses, it is concluded that the role of nonverbal factors increases. Likewise, in the progression from making to being the excuse, it is argued that self- and other-deception also become more pervasive.     

The developmental implications of migration from and between small island nations

This article discusses the role of migration in relieving population pressures, thus making continuing development possible, using small nations in the Caribbean and the South Pacific as examples. The Caribbean islands and many Pacific islands have used out-migration to ease population pressures in this century. Surplus labor has been emerging in various Caribbean nations, independent of the international marketing problems of plantation agriculture. Rural populations alienated from plantations have had to make do on questionable and/or remote land. Population surpluses appear to originate in rural areas, but little evidence exists to suggest that those surpluses are the basis for the emigration patterns of the Caribbean islands. Emigration does not solve population problems because when ambitious, skilled workers leave their country, their actions have little to do with the existence of domestic surplus labor and their leaving may do little to facilitate domestic labor absorption. Thus, if mini-states wish to sustain their hopes of economic expansion, they must find the means to employ their surplus labor. Since mainly skilled migrants leave, their going may actually slow development and retard opportunities for labor absorption. Population movements internal to the Caribbean region may further complicate surplus labor and/or population problems. If protective entry requirements impede normal inter-island relations, they may interfere with developmental processes. In general, migration is not a feasible strategy for population control for small island nations. While temporary migration has a more positive impact than other forms of migration, problems do exist. For example, temporary migration 1) can impose significant economic costs on the source-country, and 2) may result in the source country being unable to capitalize on its initial investment in training and education of temporary migrants. In conclusion, import substitution through cooperation between small island nations, production for export where feasible, and more attention to more sophisticated international service linkages hold a better prospect for material progress than relying on the export of surplus populations.