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.     

The U.S. legalization program: a preliminary final report

The Immigration Reform and Control Act (IRCA) of 1986 made 4 types of aliens eligible to receive legalization benefits: 1) those who resided "continuously" in the US since January 1, 1982; 2) those who had worked in the US perishable-crop agriculture for 90 "man-days" in specified time periods (Special Agricultural Workers [SAWS]); 3) those who were in the US since before January 1, 1972; and 4) those classified as Cuban/Haitian entrants and who had been in the US since January 1, 1982. Estimates of the number of aliens eligible for legalization, not including SAWS, ranges from 1.834 million to 2.56 million. Estimates of undercounts of undocumented aliens are 10% for those who entered before 1975 and 37.5% for those who arrived after 1975. Other refinements in the estimates of undocumented aliens include adjustments for 1) ethnic group and location, 2) the growth of the undocumented population between the census date and the legalization eligibility date under IRCA, and 3) emigration and deportation rates. Out of the 1,581,800 applicants entered into the Immigration and Naturalization Service (INS) computers (from a total of 2.15 million applicants) as of May 20, 1988, 73.7% were Mexican nationals. Only 5 other countries contributed more than 1%: El Salvador (6.5%), Haiti (2.3%), Guatemala (2.2%), the Philippines (1%), and Colombia (1%). The Mexican percentage was unexpectedly high, perhaps because the legalization had been much more successful in the Southwest than anywhere else in the country. Reasons that Mexicans have a higher legalization participation rate than other nationalities include 1) the distant eligibility date; 2) ethnic differences among non-Mexican nationalities; 3) particularly in the northeast, fears of exposing one's illegal status to INS; 4) the difficulty of information reaching ethnic communities, 5) the reluctance of those already undergoing the naturalization process to risk the legalization process; and 6) the reluctance of employees to admit employment of undocumented aliens. In the end, more than 90% of applicants are expected to be granted temporary resident alien status (and about 70% of agricultural workers), for a total of more than 2 million people. Researchers estimate that 2.5 - 3 million more persons remain in an undocumented status in the US.     

Enrich marital inventory: a discriminant validity and cross-validation assessment

To assess the validity and clinical utility of the marital inventory ENRICH, a discriminant validity study was conducted using a national sample of 5039 married couples. The sample was randomly split in order to form a cross-validation group. ENRICH is a multidimensional scale and two types of analysis were conducted to assess the value of these various scales. Results from discriminant analysis indicated that using either the individual scores or couples' scores, happily married couples could be discriminated from unhappily married couples with 85–95% accuracy. These results were cross-validated with a second sample. Using regression analysis, it was clearly demonstrated that background factors account for little of the variance in discriminating happy from unhappily married couples compared to their relationship dynamics, i.e., scale scores. All ENRICH scales except equalitarian roles proved significant, indicating the validity of a multidimensional inventory.     

Therapeutic compliments: setting the stage for successful therapy

Compliments are often viewed primarily as a linear event in which one person expresses approval or admiration of another. Far less attention has been given to the circular nature of compliments and the manner in which they enhance the positions of both the giver and the receiver of the compliment. Therapeutic compliments have proven to be highly effective means of motivating clients, while at the same time increasing therapeutic leverage. This article proposes that compliments should be purposefully given, and that the type of compliment should vary with the stage of therapy and the intended response of the client to the compliment.     

Selecting a family therapy model: the role of personality attributes in eclectic practice*

The expanding knowledge and skill bases within the interdisciplinary family therapy profession pose a significant challenge for evolving practitioners, at whatever stage along the professional development process they find themselves. This challenge raises a basic question regarding whether there are any constraining forces to the level of eclecticism in practice towards which one can aspire. This paper empirically explores the role played by the personality attributes of the family therapist in facilitating and/or inhibiting one's adherence to a variety of approaches to family practice.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

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.