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.     

Family reunification

The author explores the problem of family reunification in the context of international migration. The focus is on international and national legislation, policies, and provisions concerning family reunification. The need for international cooperation to resolve the problems arising from international migration and the desire to reunite families is noted. (SUMMARY IN FRE AND SPA)     

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.     

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.     

Migration and development: myths and reality

Recent research on the impact of labor migration on the socioeconomic development of developing countries has provided opportunity to try and resolve some of the long-standing polemics that have pervaded the literature on migration and development. This article focuses on findings concerning the labor, remittance, and social impacts of emigration on countries that have participated in labor emigration. While a great deal more research needs to be done, recent findings confirm that in some situations the sort-term impacts of labor migration on sending countries have been considerable.     

The right to life

In this issue is a lengthy, thought-provoking essay on the issues raised by unwanted pregnancy. Written by Robert Wennberg in 1984 for the Christian Scholar's Review (13:4), the article has been edited and condensed for our purposes and is quite relevant, I believe, for the student health population. Any practitioner who cares for students wrestling with these issues should at least acknowledge the moral and philosophical dilemmas presented. As one who has walked both sides of the argument, I find Wennberg's fair-mindedness compelling. In closing his article, the author raises the question of what will happen when it becomes possible to accomplish an "abortion"--or removal of the fetus from the mother--without killing the fetus. Will this procedure be acceptable to the average single college student? The New York Times, in an article on "High Tech Babies" (February 21, 1986), raised ethical questions posed by the technology of frozen embryos. Who decides what is to be done with frozen embryos? To whom do they belong? Do they have rights? The theoretical issues raised by Wennberg are already forcing themselves upon us. Whether we like it or not, the future is now. Regardless of your beliefs on this controversial topic, I urge you to read this article. Dr. Wennberg has also just completed a book on this subject, Life In The Balance.     

Problems and possibilities of development work among tribals: a participatory evaluation of a voluntary agency in India

Mandal, a church-related non-governmental voluntary agency operating in north-west India's Nasik district since 1966 was evaluated for performance in promoting self-sustaining economic growth and socio- political awareness in its beneficiaries. The research design incorporated 2 questions, the extent to which Mandal had used the integrated approach, and the extent to which it promoted structural change in the village. 2 levels of analysis were used: random samples of 315 individuals (163 beneficiaries and 152 non-beneficiaries) and data from the takatu's office for 20 involved villages and 8 control villages. Quantitative data were sought by examining files and doing closed interviews, and qualitative data were collected by observation and open-ended interviews. The variables used in the analysis were educational level, class category, caste, agricultural investment, family net income, individual consciousness and social participation. It was concluded that on the individual level some positive impact was discernible in terms of family income and agricultural investment. At the village level no quantitative improvement was measurable, but the effect of Mandal was symbolic in that it sets an example for social change. The Mandal has acquired a health, non-partisan secular image for social action.     

The protection of migrant workers and international labour standards

International labor standards take the form of Conventions and Recommendations that embody the agreements reached by a 2/3 majority of the representatives of Governments, Employers, and Workers of International Labour Office (ILO) member states. Originally designed to guard against the danger that 1 country or other would keep down wages and working conditions to gain competitive advantage and thereby undermine advances elsewhere, international labor standards have also been inspired by humanitarian concerns--the visible plight of workers and the physical dangers of industrialization and by the notion of social justice, which embraces wellbeing and dignity, security, and equality as well as a measure of participation in economic and social matters. ILO standards apply to workers generally and therefore also to migrant workers, irrespective of the fact that the general standards are complemented by standards especially for migrant workers. The social security protection of migrant workers has been dealt with in ILO instruments primarily from the angle of equality of treatment but also from that of the maintenance of acquired rights and rights in course of acquisition, including the payment of benefits to entitled persons resident abroad. The ILO Conventions on migrant workers and the Recommendations which supplement them deal with practically all aspects of the work and life of non-nationals such as recruitment matters, information to be made available, contract conditions, medical examination and attention, customs, exemption for personal effects, assistance in settling into their new environment, vocational training, promotion at work, job security and alternative employment, liberty of movement, participation in the cultural life of the state as well as maintenance of their own culture, transfer of earnings and savings, family reunification and visits, appeal against unjustified termination of employment or expulsion, and return assistance. ILO's supervisory mechanism consists basically of a dialogue between the ILO and the Government that is responsible for a law, regulation, or practice alleged to be in contravention of principles it voluntarily accepted. The control machinery is often set in motion by workers' organizations. The UN General Assembly is currently elaborating a new instrument designed to cover both regular and irregular migrant workers and their families.