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.     

Individual irrationality and social welfare

Individual preferences inconsistent with personal welfare caused neither by ignorance nor by a positive consideration for the welfare of others are defined as (welfare) irrational. Sources of irrationality (rigid adherence to moral principles, excessive fear of danger, excessive tempetation of pleasure, revenge, inertia, faulty telescopic faculty, the fallacy of diminishing marginal utility of utility, etc.) are discussed. An evolutionary explanation of irrationality is suggested and some implications for individual decision and social policy indicated.I am grateful to two anonymous referees for comments.     

Policies over time and pareto optimality

This paper is concerned with sequences of policies that occur over time in voting models and planning procedures. The framework for our analysis includes assumptions that are satisfied by models in the corresponding literatures, together with other standard assumptions for microeconomic analysis that involve time. The starting point for our analyses is the prespective that results from combining the following (widely held) views: 1) certain voting models and planning procedures can be interpreted as being non-tatonnement or sequential processes (where each policy in the sequence that is generated is actually experienced by voters or consumers) and 2) an alternative being Pareto optimal in any given period (temporal Pareto optimality) is the appropriate efficiency criterion only if the alternative is the final outcome from a tatonnement process-and that, otherwise, one should examine the efficiency of the entire path (using intertemporal Pareto optimality). Our first observation about the planning literature is that is has (by and large) neglected the efficiency criterion that is appropriate for the discrete-time procedures that can be interpreted as non-tatonnement or sequential processes-and that, what's more, such trajectories will (in general) fail to meet this criterion. Our second observation identifies some results that can be used to establish that some of these trajectories will at least be ultimately intertemporally Pareto optimal. In our discussion of voting theory, we review Buchanan's opposition to requiring (social) choice consistency for voting procedures-and his argument for this position on (Pareto) efficiency grounds. We then consider voting procedures that can be interpreted as non-tatonnement or sequential processes and arrive at the conclusion that, in these cases, (i) majority rule cycles are intertemporally Pareto inefficient and (ii) achieving intertemporal Pareto optimality requires choice consistency. We then go on to show that related observations apply to Kramer's normative conclusions about his dynamical model of political equilibrium — and identify some further references where similar observations apply. In the final part of our discussion of voting models, we arrive at the further conclusion that, in the most relevant cases, a trajectory that stays in the temporal Pareto set is not necessarily more desirable (on efficiency grounds) than one that doesn't.This paper has been improved by helpful comments and suggestions that have been provided by Kenneth Arrow, an anonymous referee, and the editor who handled the paper.Peter Coughlin gratefully acknowledges financial support provided by (i) National Science Foundation Grant No. SES-8409352, and (ii) the Center for Advanced Study in the Behavioral Sciences at Stanford (with support from National Science Foundation Grant No. BNS-8700864 and the Alfred P. Sloan Foundation).     

Social choice theory in the case of von Neumann-Morgenstern utilities

Part I of this paper offers a novel result in social choice theory by extending Harsanyi's well-known utilitarian theorem into a multi-profile context. Harsanyi was contented with showing that if the individuals' utilities u _i are von Neumann-Morgenstern, and if the given utility u of the social planner is VNM as well, then the Pareto indifference rule implies that u is affine in terms of the u _i. We provide a related conclusion by considering u as functionally dependent on the u _i, through a suitably restricted social welfare functional (u ₁,...,u _n)u=f(u ₁,...,u _n). We claim that this result is more in accordance with contemporary social choice theory than Harsanyi's single-profile theorem is. Besides, harsanyi's initial proof of the latter was faulty. Part II of this paper offers an alternative argument which is intended to be both general and simple enough, contrary to the recent proofs published by Fishburn and others. It finally investigates the affine independence problem on the u _i discussed by Fishburn as a corollary to harsanyi's theorem.The authors are indebted to L. Haddad, A. Sen and two anonymous referees for useful written comments. They also benefited from stimulating remarks in seminars and helpful conversations with their colleagues. The usual caveat of course applies. One of the authors acknowledges partial financial support from the ARI Communication of the C.N.R.S., Paris.     

The American commune and the American mythology

While the symbolic value of community has long been recognized, most of the attention to date has focussed on the symbolic content of the American small town, taken as representing the most fundamental and lasting values and characteristics of the American Way of Life (Vidich and Bensman, 1968, Caplowet al., 1982).Here it is argued that communities existing not in the cultural center but rather on the periphery also contain symbolic potency and are so interpreted by the dominant society. As is demonstrated by the case of the Amana Colonies, such communities represent the Other within. They present both the possibility of cultural alternatives and the ultimate victory of mainstream values and structures. The tension between history and myth, community and society, is then related to interpretation of other communal societies and their relationship to the dominant American society.For helpful comments on an earlier version, I would like to thank David Bouchier and Maren Lockwood Carden.     

A quantitative theory of preferences: Some results on transition functions

We investigate a general theory of combining individual preferences into collective choice. The preferences are treated quantitatively, by means of preference functions (a,b), where 0(a,b) expresses the degree of preference of a to b. A transition function is a function (x,y) which computes (a,c) from (a,b) and (b,c), namely (a,c)=((a,b),(b,c)). We prove that given certain (reasonable) conditions on how individual preferences are aggregated, there is only one transition function that satisfies these conditions, namely the function (x,y)=x·y (multiplication of odds). We also formulate a property of transition functions called invariance, and prove that there is no invariant transition function; this impossibility theorem shows limitations of the quantitative method.Research supported in part by the National Science Foundation.     

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.