MIGRATION OF HEALTH PERSONNEL, SCIENTISTS, AND ENGINEERS FROM LATIN AMERICA

Transcription

1 MIGRATION OF HEALTH PERSONNEL, SCIENTISTS, AND ENGINEERS FROM LATIN AMERICA u: PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Reginal Office f the WORLD HEALTH ORGANIZATION 966

2 MIGRATION OF HEALTH PERSONNEL, SCIENTISTS, AND ENGINEERS FROM LATIN AMERICA )ZZE Reprt prepared by the PAHO Subcmmittee n Migratin fr the PAHO Advisry Cmmittee n Medical Research Scientific Publicatin N. 4 September 966 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Reginal Office f the WORLD HEALTH ORGANIZATION 55 Twenty-third Street, N.W. Washingtn, D.C. 7, U.S.A.

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4 * * ib PAHO ADVISORY COMMITTEE ON MEDICAL RESEARCH Dr. Hernán Alessandri Ex-Decan, Facultad de Medicina Universidad de Chile Santiag, Chile Dr. Ott Bier Departament de Micrbilgia e Imunlgia Escla Paulista de Medicina Sá Paul, Brazil Dr. Rbert Caldeyr-Barcia Jefe, Servici de Fisilgía Obstétrica Facultad de Medicina Mntevide, Uruguay Dr. Carls Chagas Chief, Brazilian Delegatin t UNESCO Paris, France Dr. Ignaci Chávez Ex-Rectr, Universidad Nacinal Autónma de Méxic Mexic, D.F., Mexic Dr. René Dubs Prfessr and Member The Rckefeller University New Yrk, New Yrk, U.S.A. Dr. Bernard A. Hussay Directr, Institut de Bilgía y Medicina Experimental Buens Aires, Argentina Dr. Albert Hurtad Decan, Facultad de Medicina Universidad Peruana Cayetan Heredia Lima, Peru Dr. Walsh McDermtt Chairman, Department f Public Health Crnell University Medical Cllege New Yrk, New Yrk, U.S.A. Dr. James V. Neel Department f Human Genetics University f Michigan Schl f Medicine Ann Arbr, Michigan, U.S.A. Dr. Anthny M.-M. Payne Chairman, Department f Epidemilgy and Public Health Yale University Medical Schl New Haven, Cnnecticut, U.S.A. Dr. Marcel Rche Directr, Institut Venezlan de Investigacines Científicas Caracas, Venezuela Dr. James A. Shannn Directr, Natinal Institutes f Health Bethesda, Maryland, U.S.A. Dr. J. C. Waterlw Trpical Metablism Research Unit University f the West Indies z Kingstn, Jamaica Prfessr Abel Wlman Emeritus Prfessr f Sanitary Engineering and Water Resurces The Jhns Hpkins University Baltimre, Maryland, U.S.A. Dr. M. Martins da Silva Chief SECRETARIAT Office f Research Crdinatin Mr. Luis Munan Research Scientist PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau Dr. Abraham Hrwitz, Directr iii

5 4t PAHO SUBCOMMITTEE ON MIGRATION Dr. Hernán Alessandri Dr. Rbert Caldeyr-Barcia Dr. Carls Chagas Dr. Ignaci Chávez Dr. Bernard A. Hussay Dr. Albert Hurtad Dr. Charles V. Kidd, Chairman Dr. Marcel Rche Cnsultants Dr. Kelly M. West University f Oklahma Oklahma City, Oklahma, U.S.A. Dr. Hernand Grt Universidad de ls Andes Bgtá Clmbia iv

6 CONTENTS Page FOREWORD... ix. Intrductin.... Wh Migrates? Migratin by Prfessin The Special Case f Physicians What Causes Migratin? What Shuld Be Dne? BIBLIOGRAPHY Appendices I. Migratin f Trained Peple frm Latin America-Statement f Gals and Prcedures fr a Study II. Immigrants Admitted t the United States in the Prfessinal, Technical, and Kindred Wrker Grup, by Cuntry r Regin and by Occupatin III. Latin American Scientists in the United States, by Highest Degree, Citizenship, and Field, IV. Latin American Medical Graduates in the United States, by Schl and Cuntry f Origin V. Latin American Medical Graduates Licensed by Examinatin t Practice in the United States, VI. Status in the United States f Graduates f the University f Buens Aires, the Natinal University f Mexic, and Clmbian Medical Schls... VII. Special Nte n the Migratin f Cuban Physicians... 7 VIII. Questinnaire fr Latin American Medical Graduates in the United States... 9 IX. Establishment f a Special Cmmittee t Study the Migratin f Argentine Scientists, Prfessinals, Technicians, and Skilled Wrkers-Decree 7,558 f X. Custms Exemptins fr Argentine Scientists, Universitylevel Prfessinals, and Technicians-Decree,754 f v

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8 Table Table Tables and Figures Page Persns Engaged in Six Principal Prfessins, in Five Latin American Cuntries, University Graduates in Given Years, Selected Prfessins, in Eighteen Latin American Cuntries... Figure Prfessinal, Technical, and Kindred Wrkers Admitted as Immigrants t the United States, frm Selected Areas in the Americas, Table Table 4 Figure Table 5 Figure Figure 4 Table 6 Table 7 Mvement f Prfessinal and Technical Wrkers In and Out f Argentina, Physicians Admitted t the United States, by Cuntry f Birth and by Cuntry f Last Permanent Residence, Selected Cuntries and Regins, 964. Prfessinal, Technical, and Kindred Wrkers Admitted as Immigrants t the United States, frm Selected Cuntries f the Americas, Persns Admitted t the United States with Immigrant Visas, frm Suth America, Argentina, and Clmbia, Selected Prfessins, Ptential Lss f Prfessinal and Technical Wrkers, by Cuntry, Latin America, Persns Admitted t the United States with Immigrant Visas frm Latin America, Selected Cuntries and Occupatins, Nurses and Medical Technicians frm Latin America Admitted t the United States with Immigrant Visas, Engineers frm Latin America Admitted t the United States with Immigrant Visas, Figure 5 Ptential Lss f Engineers by Cuntry, Latin America, Table 8 Table 9 Table Table Figure 6 Latin American Students in the United States, by Field f Majr Interest, Percentages f Graduate Students in Selected Fields f Specializatin, in Seven Latin American Cuntries, Latin American Citizens Recruited Internatinally fr Internatinal Agencies, Latin American Citizens Recruited Internatinally fr Internatinal Agencies, Representatin by Grups f Cuntries, U.S. Immigrant Visas t Graduates f Latin American Medical Schls, Figure 7 U.S. Licenses t Latin American Medical Graduates, vii

9 Page Table Graduates f Freign Medical Schls Residing in the United States, Table Physicians Admitted t the United States with Immigrant Visas, Table 4 Figure 8 Figure 9 Latin American Medical Schls Having the Largest Number f Graduates in the United States, Ptential Physician Immigrants t the United States per Millin Ppulatin, Ptential Physician Immigrants t the United States as a Percentage f Annual Output f Physicians, Table 5 Bimedical Research Trainees frm Latin America Supprted by NIH Training Grants t U.S. Institutins... Table 6 NIH Internatinal Pstdctral Fellwships t Latin Americans, Table 7 Table 8 Table 9 Frmer NIH Research Trainees frm Latin America, Fllw-up and Citizenship Status in Cmparative Incme Distributin f Chilean Migrants t the United States, Befre and After Migratin, as f Migratin f Prfessinal, Technical, and Kindred Wrkers frm Argentina, Crrelated with Dmestic Cnditins... 4 viii

10 FOREWORD This study was suggested by the Pan American Health Organizatin in its reprt Science Plicy in Latin America (PAHO Scientific Publicatin 9, March 966). The reprt made the fllwing recmmendatin: "The Pan American Health Organizatin shuld institute a study f the migratin f scientists, in cperatin with all grups that have an interest in the questin, fr the purpse f btaining a mre specific diagnsis and a practical prescriptin." A Subcmmittee n Migratin was frmed, and Dr. Charles V. Kidd f the Office f Science and Technlgy, Executive Offices f the President f the United States, was asked t prepare a draft statement f gals and prcedures fr a study (see Appendix I). This was dne with the cllabratin f Dr. Kelly West, Prfessr f Cntinuing Educatin, University f Oklahma Schl f Medicine. A preliminary draft was reviewed by the Subcmmittee at a meeting in Ri de Janeir in May 966, and a revised draft was subsequently reviewed and discussed by the PAHO Advisry Cmmittee n Medical Research at its Fifth Meeting in June 966. The final reprt was then prepared by Dr. Kidd. The Department f Scientific Affairs f the General Secretariat f the Organizatin f American States, which is engaged in establishing a mre effective base fr manpwer statistics in Latin America, was extremely helpful in prviding data. Hpefully, the present explratry study n migratin will prvide guides t the kind f data that shuld be cllected and analyzed n a lng-term basis. The American Medical Assciatin and the Immigratin and Naturalizatin Service f the U.S. Department f Justice kindly made available previusly unpublished data. The Natinal Science Fundatin als made available special data derived frm the Natinal Register f Scientific and Technical Persnnel. Thanks are extended t the many individuals wh respnded t questinnaires, t busy gvernment fficials wh tk the time t supply data and judgments, and t many scientists wh gave their ideas in persnal interviews. ix

11 . INTRODUCTION. The Basic Significance f Migratin Mdern ecnmics is attaching new significance t tw factrs hithert nt strngly emphasized: the effect f the quality f the wrk frce n ecnmic well-being, and the impact f science and technlgy n ecnmic develpment. With regard t the first, earlier ecnmic analysis had dealt with the wrk frce as if it were cmpsed f equally effective units f unchanging capacity. Later studies have clearly demnstrated, hwever, that the educatin, health, alertness, and mtivatin f wrkers cnstitute a majr factr in ecnmic develpment. Thus, thery, after many years, has almst vertaken cmmn sense. As t the rle f science and technlgy, reassessment in recent years has shwn that innvatin in prducts and in prductin techniques turns the prcess f change itself int an imprtant factr f ecnmic grwth. This is a basic shift frm the earlier views f ecnmic therists, which essentially stressed imprvement in the efficiency f existing prcesses fr the utput f existing gds. When these tw factrs, the significance f wrk-frce quality and the effects f science and technlgy, are cnsidered tgether, the critical imprtance f scientists, engineers, and physicians t natinal develpment becmes evident. While, n ne hand, a balanced, high-quality ttal wrk frce is imprtant and necessary, n the ther hand, scientists, engineers, and physicians cmprise a grup f singular significance t develping natins. In additin t having an ecnmic value, these highly trained peple cnstitute the small slice f the ppulatin that prvides intellectual, plitical, and cultural leadership. Any measures that increase the supply f such peple are imprtant. Similarly, any factrs that cntribute t a decrease are significant. Migratin is ne such factr. In a number f cuntries f Latin America, many scientists have becme s discuraged by the bstacles t a career in science and teaching that they have migrated. They are, in effect, pushed ut f their native cuntry. At the same time, they are pulled tward cuntries where career prspects are much brighter in bth ecnmic and intellectual terms. The cuntry that has held the mst attractin in recent years is the United States. While exact and full details cncerning the migratin f physicians, scientists, and engineers are nt knwn, it is abundantly clear that the lss f such talent is in sme cuntries a severe handicap t natinal ecnmic, cultural, and intellectual develpment. It is als dear that the situatin differs widely frm ne cuntry t anther. Much mre attentin has been paid t the flw f capital than t the flw f brains. Physicians and bimedical scientists are an imprtant case in pint. Hwever, like s many aspects f the science field in Latin America, the prblem f this grup can be adequately understd nly in the cntext f the ver-all prfessinal picture.

12 The central questin is nt whether the frces that repel r thse that attract are mst pwerful; it is, rather, hw bth these frces can be mderated in a suitable way. There can be n realistic hpe that the frces leading t migratin f scientists frm Latin America will be eliminated and that migratin will cease. The frces at wrk are t deeply ingrained and t pwerful. Indeed, the cessatin f migratin is nt nly impssible but unwise. Internatinal migratin f scientists is a prductive phenmenn with which the wrld has lng been familiar. The bject f plicy shuld be t establish cnditins under which the rate f migratin frm Latin America may be mderated by vluntary individual decisin. Frtunately, practical, inexpensive measures fr reducing migratin d, in fact, exist. The present study first summarizes all the facts that culd be btained n the subject. With the cperatin f the natins cncerned, the numbers and characteristics f migrants have been reasnably well identified. It then analyzes the frces leading t migratin. Finally, it suggests measures t recncile the legitimate aspiratins f highly trained peple with the legitimate needs f the cuntries fr highly trained manpwer.. Migratin Defined The fcus f the reprt is n permanent rather than temprary change f an individual's cuntry f residence. All kinds f temprary changes f residence are excluded. Fr example, the sjurns f thusands f Latin American students wh cme t the United States t study and then return hme are nt cunted as migratin. Study in the United States, hwever, is regarded as a factr affecting migratin, since the pprtunity t learn abut the United States and t becme familiar with the English language unquestinably plays a part in the ultimate decisin t migrate. Visits t the United States fr business r pleasure are als excluded frm the study.. The Cuntries f Latin America Fr the purpse f this study, the term "Latin America" shall include the fllwing cuntries: Mexic Csta Rica El Salvadr Guatemala Argentina Blivia Brazil Guyana* Chile Clmbia * Frmerly British Guiana. Hnduras Nicaragua Panama Ecuadr Paraguay Peru Surinam Uruguay Venezuela Althugh this classificatin excludes the Caribbean cuntries, certain data n them will be presented..4 Migratin t the United States The riginal intent f this study was t examine the migratin patterns f scientists, engineers, and physicians and ther health persnnel frm all Latin American cuntries t all ther cuntries. Hwever, it sn became evident that, practically speaking, the nly cuntry t which peple frm Latin America migrate in significant numbers-numbers sufficient t aruse cncern n the part f the cuntries being left-is the United States. Migratin f highly trained Latin Americans t Eurpe and t ther parts f the wrld has nt reached high enugh levels t cause general cncern, althugh migratin t Eurpe shws signs f increasing. Fr these reasns, it was decided t cnfine the study t migratin t the United States. L

13 .5 Availability f Migratin Statistics Enugh is knwn almst entirely frm surces within the United States abut the numbers and characteristics f migrants frm Latin America t the United States t prvide a basis fr natinal plicies and actin. The frmulatin f plicies in this field des nt depend n precise statistics; knwledge f the general magnitude, nature, and causes f a prblem is an adequate guide fr actin. Indeed, there is n reasn why an apprpriate actin prgram shuld be affected even by quite substantial changes in magnitudes. Unfrtunately, detailed facts that wuld further illuminate prblems, guide prgrams, and stimulate actin by prfessinal and ther grups are nt available. Data n the varius prfessins-the number f peple wrking and the number graduating annually in each ne (Tables and )-are inadequate in mst Latin American cuntries. Such infrmatin is necessary t assess the significance f migratin figures. This type f data can be prduced nly by a general strengthening f natinal manpwer statistics. Such a prgram is nw being advcated, aided, and implemented by the Organizatin f American States. The vlume f migratin int the Latin American cuntries is almst entirely unknwn. The wide disseminatin f the few facts available has had unfrtunate cnsequences. The mst serius effect has been an exaggerated idea f the number f migrants. Anther TABLE. PERSONS ENGAGED IN SIX PRINCIPAL PROFESSIONS, IN FIVE LATIN AMERICAN COUNTRIES, Prfessinal Argen- Clm- Ecuagrup Brazil Chile tina bia dr Physicians 5, 5,4 7,5,5 Engineers 5,,7 7,, Lawyers,9 Dentists, 4,,5 Pharmacists, Architects 4,7 Surce: UNESCO, Ls Estudis de Recurss Humans en el Cntext de la Planificación y en Metdlgía en América Latina (paper prepared fr the Cnference n the Applicatin f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September 965), Cuadr 5. TABLE. UNIVERSITY GRADUATES IN GIVEN YEARS, SELECTED PROFESSIONS, IN EIGHTEEN LATIN AMERICAN COUNTRIES Natural Cuntry Year Humanities Engineering sciences Law Medicine Csta Rica Cuba Dminican Republic El Salvadr Guatemala Haiti Hnduras Jamaica Mexic Argentina Brazil Chile Clmbia Ecuadr Paraguay Peru Uruguay Venezuela ,566, ,67, Surce: Prepublicatin extract frm the UNESCO Statistical Yearbk fr nA ,4, ,4 4,6,

14 cnsequence is that discussins f migratin have been placed in a rather theretical light. The absence f sund data has led peple t search fr any facts at all that might illuminate the situatin. In Mexic, fr example, experts studying the supply and demand fr physicians have had t rely n statistical reprts f physicians tested fr practice in the United States. On this basis, they arrived at the fllwing estimate: Sme 5 yung physicians frm Mexic are tested annually fr settling and practicing in the United States. Of these, are graduates frm the Medical Schl f the Natinal University and the remaining 5 are graduates frm State medical schls. Frm 66 t 75 per cent pass the test successfully the first time; thse wh fail have the pprtunity f passing the test at a later date. Thus, Mexic lses physicians per year. Actually, the maximum annual number f physicians migrating frm Mexic t the United States between 96 and 965 has been abut 8. In the absence f precise data, the Mexican estimate was remarkably accurate and prvided an rder f magnitude nt at all misleading in terms f plicy implicatins. Thus, any cuntry culd take the number f its physicians wh pass the test f the Educatinal Cuncil n Freign Medical Graduates as a usable measure f migratin. Argentina, hwever, made a rather serius errr sme years back. On the basis f n facts whatever, a statement was made that Argentina had lst 5, engineers t the United States. N surce was specified and n time perid was given. The true figures indicated that a maximum f 7 engineers had migrated t the United States ver the perid But the real situatin was serius enugh in itself, since the number f migrants D. G. Alarcón, Evaluación de la Necesidad de Médics de la Reública Mexicana y Planeación de la Enseñanza Médica, Méxic, D.F., Facultad de Medicina, Universidad Autónma de Méxic, 965. M. A. Hrwitz, La Emigración de Prfesinales y Técnics Argentins, Buens Aires, Institut Trcuat di Tella, 96, p.. 4 equaled 8 per cent f the number f new engineers graduating ver the perid Far mre serius than the inadequacy f statistics, hwever, is the lack f interest, cncern, and actin that prevails with regard t the migratin prblem..6 Interpretatin f Migratin Statistics Figures n migratin are quite abundant in the United States, particularly frm the Immigratin and Naturalizatin Service f the U.S. Department f Justice. These statistics indicate by cuntry and by ccupatin, fr every year, the number f persns admitted as immigrants t the United States (Appendix II). S far as is knwn, n cmparable infrmatin is available in any ther cuntry in the Western Hemisphere. Data with respect t physicians wh have cme t the United States frm ther cuntries are als available in great detail. Finally, the Institute f Internatinal Educatin in New Yrk cllects and publishes annual infrmatin n freign students in the United States in its reprt Open Drs. The precise meaning f all these data must be understd befre they can be interpreted and prperly used. Every effrt has been made in this reprt t interpret the available statistics crrectly and t nte their limitatins. Lack f understanding f the true meaning f statistics can lead t misinterpretatin and cnfusin. T take a specific example, the number f physicians wh enter the United States in a given year frm a given cuntry is nt the same as the number wh migrate. The ttal number entering the United States indudes turists, interns, and residents, as well as fully trained physicians wh intend t engage in the practice f their prfessin. The number entering the United States is always greater then the number wh migrate, but hw much greater is difficult t say. Often when

15 individuals enter the United States they themselves d nt knw whether they will eventually migrate, and peple ften change their minds. Smetimes figures relating t the ttal mvement t the United States are cited as if they were numbers f immigrants, thus leading t exaggerated ideas with respect t the magnitude f the prblem. This reprt is riented twards plicy decisins-twards what can and shuld be dne t mderate migratin where it seems excessive. In such a cntext, extreme refinement f statistical data is nt required. The statistics are a guide t the nature and magnitude f the prblem t be slved, and nt an end in themselves. Frtunately, gd judgments as t the seriusness f the migratin prblem can be made n the basis f rugh data, since any actin that might be taken is the same ver a fairly wide range. T take an example, 8 physicians frm Clmbia were admitted t the United States as immigrants in 965. With respect t any actin Clmbia might find desirable and pssible t take, it wuld nt make much difference if this figure were 6 r. And it wuld nt make much difference whether r per cent f thse admitted as immigrants later decided t return t Clmbia. The prblem fr Clmbia is essentially the same ver the pssible range f figures. This example, taken at randm, applies t all Latin American cuntries. The fact that statistics are adequate fr a study f this srt des nt mean that they are adequate fr all purpses. Mre refined data, and interpretive studies based n such data, are needed. Hwever, the factual base fr brad plicy decisins and fr actin exists. 5

16 - -. WHO MIGRATES?. The Brad Tides f Mvement Over the past five years, apprximately 4, university-educated persns have entered the United States frm Latin America with immigrant visas. Abut three quarters f these, r sme,, are prbably permanent migrants. If the cst f training ne persn is cnservatively estimated at $,, the lss t the Latin American cuntries caused by the migratin f, university-trained peple t the United States, measured slely in terms f educatin cst, has been in the neighbrhd f $6,, ver the past five years. The number f prfessinal, technical, and kindred wrkers migrating t the United States frm Latin America, and particularly frm Suth America, is becming greater each year (Figure ). The ttal in 96 was abut,, and in 965 it was abut 5,4. The number f migrants frm Suth America increased frm,9 in 96 t,6 in 965, and the Central FIG.. PROFESSIONAL, TECHNICAL, AND KINDRED WORKERS ADMITTED AS IMMIGRANTS TO THE UNITED STATES, FROM SELECTED AREAS IN THE AMERICAS, , _/ CUBA : LU,t SOUTH AMERICA r en, CENTRAL AMERICA- L~ l Y E A R S

17 American annual ttal went frm 55 t 9 during the same perid. Thse frm Mexic increased frm 6 t 9. Over the perid, a ttal f 9, prfessinal, technical, and kindred wrkers entered the United States frm Latin America with immigrant visas. Of these,,9 were frm Mexic,,5 frm Central America, and,7 frm Suth America. Unless specifically mentined, emigratin frm Cuba is nt included in this summary because f the unique circumstances in that cuntry. Migrants frm the West Indies are als excluded. The number f actual migrants (persns wh remain permanently in the United States) is less than these figures indicate, since a large but unknwn number f entrants secure immigrant visas even thugh they return t their wn cuntries after a shrt perid in the United States. Fr purpses f cnsidering plicy and actin, hwever, the number entering with immigrant visas will be cnsidered as the number f migrants, with the understanding that this figure is smewhat high. In n Latin American cuntry is the lss f highly trained peple t the United States as significant as the lsses experienced by the Philippines, India, Turkey, Krea, and Iran. Even fr certain Western Eurpean cuntries the mvement t the United States is mre significant, in terms f the prprtin f highly trained peple wh migrate as well as in terms f numbers, than it is fr the Latin American cuntries. Fr example, the number f scientists and engineers wh migrated frm the Netherlands, Nrway, and Switzerland in 959 amunted t between 5 and 7 per cent f the year's ttal graduates in these particular prfessins. Thus, the situatins f ther cuntries can prvide a useful pint f reference frm which t assess the significance f migratin frm Latin America. The relatively high rates f migratin frm Western Eurpe as cntrasted with Latin America testify t the cmplexity f the frces affecting migratin and t the fact that much mre than ecnmic factrs are invlved. The real incme f the average prfessinal persn is much greater in Western Eurpe than in Latin America. Therefre, if nly ecnmic factrs perated, ne wuld expect migratin t the United States t be much mre prevalent frm Latin America than frm Western Eurpe. Yet the migratin rate frm Western Eurpe is as great r greater than that frm Latin America. The ttal emigratin t the U.S.A. frm Western Eurpe (France, Germany, the Netherlands, and the United Kingdm) amunted t 6,5 scientists and engineers frm 956 t 96, prbably equivalent t abut 6 per cent f Western Eurpean new graduates in science and engineering in thse years. This was equivalent t abut per cent f new graduates in science and 9 per cent f new graduates in engineering. Viewed frm this perspective, the wnder is nt why s many Latin American engineers, scientists, and physicians migrate t the United States, but rather why s few migrate. Tw imprtant and related cnsideratins are raised by this questin. First, it is evident that the existence f relatively lw incme pprtunities fr individuals in a given cuntry des nt necessarily lead t migratin. Cuntries with relatively lw per capita incme need nt be fatalistic abut the migratin questin; they d nt have t apprach the level f the United States in rder t keep migratin within reasnable bunds. Secnd, the fact that ut-migratin t the United States frm Latin America has nt been as heavy as migratin frm Western Eurpe, even thugh average incme levels are lwer in Latin America, suggests that significant nnecnmic factrs inhibit migratin frm Latin America. C. Freeman and A. Yung, The Research and Develpment Effrt in Western Eurpe, Nrth America, and the Sviet Unin, Paris, Organisatin fr Ecnmic C-peratin and Develpment, 965, p

18 The primary difficulties generated fr Latin American cuntries by migratin cme less frm the lss f abslute numbers than frm the lss f a critical few highly qualified prfessinal peple. These peple-engineers, scientists, physicians, and the like-cntribute t natinal develpment nt nly by practicing their prfessins but als by serving, in the capacity f teachers and intellectual leaders, as agents f change. The narrwer the humanresurce base f any natin, the mre significant is the lss f small numbers f highly trained peple. The imprtance f migratin t Latin American cuntries must therefre be measured in terms f the prprtin f the highly skilled labr frce that migrates as well as in terms f the number wh migrate. The lss f teacher-investigatrs is particularly serius, since these are the peple respnsible fr expanding the future supply f prfessinals. The shrtage f teacher-investigatrs is illustrated by the situatin in engineering and medicine. In all f Latin America, abut 5, engineers devte sme time t university teaching. Of these, hwever, nly, are full time, even in the sense f spending a frmal full wrk week at the university. A still smaller number devte themselves cmpletely t academic wrk. Only 6 t 7 engineers in all f Latin America are engaged exclusively in academic teaching and research.4 In medicine the prprtin f prfessinally trained persns wh devte themselves cmpletely t university teaching and research is a little larger, but nt much. The prprtin in science, hwever, is definitely higher, and f the same number f engineers and scientists wh migrate a much larger number f teacherinvestigatrs will be fund amng the scientists. The better the scientist and the better the labratry in which he wrks, the mre likely 4 UNESCO, Persnal Dcente, Niveles, Grad de Especialización, y Cndicines de Ingres en Estudis de Ingenieria (dcument prepared fr the Cnference n the Applicatín f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September 965), p.. 8 he is t be ffered an pprtunity t wrk in a labratry in the United States. Even the utstanding labratries in Latin America have difficulty at times in prviding the resurces investigatrs cnsider essential fr the ptimum prgress f their research. Graphic examples f this cnditin can be cited frm labratries with which members f the PAHO Advisry Cmmittee n Medical Research are assciated. The lss f highly talented leaders thrugh migratin cannt be measured by statistics, fr a persn with the extrardinary gifts f leadership is uniquely valuable and may be wrth r persns wh have a high degree f prfessinal training but d nt have these rare persnal attributes. Every cuntry has a small nucleus f persns with the cmbinatin f leadership qualities needed fr establishing institutins and ensuring their grwth, prductivity, vitality, and stability. These institutins may be ministries, prfessinal parts f ministries, independent institutes, universities, r parts f universities. Infrmed peple in virtually every Latin American cuntry can name persns f utstanding talent wh have migrated t the United States. The numbers vary frm cuntry t cuntry and they are small, but they cnstitute a serius blw t develpment. On the whle, these lsses seem t be mre serius in medicine and science than in engineering. The number f scientists wh had their secndary schling in Latin America and are nw wrking in the United States may serve as a rugh guide t the vlume f migratin f highly trained peple. In 964, 7 scientists with a Ph.D. degree and anther 6 with a prfessinal medical degree wh had their secndary schling in Latin America were wrking in the United States (Appendix III). Three quarters f them came frm Argentina, Brazil, Clmbia, Mexic, and the West Indies. The prblem cannt be assessed statistically, and there is n pint in attempting t d s. The critical fact is that the dimensin f quality must be brne explicitly in mind when statistics are examined. r.

19 . The Cmplex Flw f Peple While the flw f highly trained peple t the United States frm Latin America has been the clearly dminant pattern f migratin, ther paths f mvement are significant as well. These include such patterns as migratin frm utside the hemisphere t Latin America befre entering the United States and migratin within Latin America... Migratin frm Eurpe after Wrld War II The student f migratry mvements within the Western Hemisphere shuld keep in mind that all the peple but the Eskims and the Indians are either migrants r descendants f migrants. And the flw f peple t the hemisphere has nt ceased. Abut 4.4 millin peple migrated frm Eurpe and Russia during the decade immediately fllwing Wrld War II.5 Of these,. millin came t the United States and. millin t Latin America. Of the grup that migrated t Latin America, 6, came t Argentina,, t Venezuela, and, t the ther cuntries. Althugh scientists, engineers, and physicians may cnstitute a much smaller prprtin amng these immigrants t Latin America than they d amng the migrants leaving the area, even s, the ttal flw f peple t Latin America has been s much greater than the utmigratin that the regin as a whle has had an imprtant net in-migratin f scientists, engineers, and physicians since Wrld War II. The pattern has cnsisted f a heavy inflw frm Eurpe and a much smaller utflw almst entirely t the United States. While the pst-wrld War II mass migratin frm Eurpe t Latin America has sharply diminished, migratin n a smaller scale t particular areas and in particular ccupatins 5 D. Kirk, Majr Migratins Since Wrld War II, in Milbank Memrial Fund, Selected Studies f Migratin Since Wrld War II, New Yrk, 958. cntinues. Fr example, an imprtant surce f in-migratin t Latin America is the mvement f prfessrs frm Eurpe under the auspices f the Intergvernmental Cmmittee fr Eurpean Migratin. Between January 964 and April 966 the Cmmittee spnsred the relcatin f 6 Eurpean prfessrs in the fllwing Latin American cuntries: Ttal Clmbia... Brazil... Ecuadr... Csta Rica... Nicaragua... Chile... Guatemala... Venezuela... By field, they were distributed as fllws: Ttal Physical sciences... Scial sciences... Agricultural and bilgical sciences... Engineering These peple, very few f whm have subsequently migrated t the United States, are making an imprtant cntributin t the develpment f Latin America. While data are incmplete, it appears that ver recent years mst migrants t Latin America in the prfessinal categries have cme t Argentina, Mexic, Venezuela, and Clmbia. Argentina has the mst extensive data. Argentina is a "cuntry f immigrants." If the cuntry had received n migrants ver the last years the current ppulatin wuld be nly 45 per cent f what it is tday. 6 As late as 94, per cent f the ppulatin f Argentina was freign brn. In 964 the net migratin t Argentina had reached a cumulative level f 5.7 millin in a cuntry f millin. 6 Z. de Lattes, Cnsecuencias Demgráficas de ls Mvimients Migratris Nacinales en la República Argentina, (paper prepared fr the United Natins Wrld Ppulatin Cnference, Belgrade, 965). 9

20 During the years since Wrld War II, Argentina has cntinued t be a cuntry f net in-migratin. Over the perid ,,858 persns in the prfessinal and technical categry migrated t Argentina frm all ther cuntries while,5 such persns migrated frm Argentina t the United States (Table ). TABLE. MOVEMENT OF PROFESSIONAL AND TECHNICAL WORKERS IN AND OUT OF ARGENTINA, Immigratin Year frm all cuntries* Emigratin t the U.S. Net immigratin Ttal,858, ,59-7 Surce: Argentina, Ministeri del Interir, Dirección de Migracines, La Emigración de Técnics Argentins, pr H.P.O. Ciapusci, Buens Aires, 965 (typewritten study). * The immigratin figures include nly persns wh have becme Argentine citizens; they d nt include persns wh remain in Argentina fr varius perids but wh d nt becme citizens. In all prbability, the cuntry gained abut as many prfessinal and technical wrkers as it lst ver the perid in questin. This assessment, hwever, des nt take int accunt the qualificatins f the individuals in the tw grups, and it is quite pssible that mre utstanding individuals left the cuntry than entered. Still, the basic fact that Argentina has experienced nly a small net lss f prfessinal and technical persns ver recent years is nt generally appreciated. Very little ccupatinal data are available n in-migrants. A special study f engineers migrating t and frm Argentina 7 shws that althugh 77 left t cme t the United States, 7H.P.O. Ciapusci, "Emigración e Inmigración de Técnics," Revista de la Dirección Nacinal de Migracines, Buens Aires, 965. Ciapusci pints ut that 96 was nt a particularly favrable year fr Argentina, but it was the year fr which detailed ccupatinal statistics were btained. 97 entered Argentina with the intentin f remaining permanently and anther 46 entered n a temprary basis. This "crss migratin" is primarily the result f specific prfessinal requirements generated by a develping ecnmy and the inability f the lcal universities t prvide the needed training. The amunt f permanent in-migratin f all classes f prfessinals t Latin America is nt knwn. Whether mre detailed study wuld bring t light situatins like that f Argentina is prblematical. The data n in-migratin t Venezuela cited in the fllwing sectin are f interest in this cnnectin... Migratin befre entering the United States While mst migrants t the United States enter directly frm their cuntry f birth, sme enter frm anther cuntry t which they have migrated first. Fr example, 44 physicians entered the United States frm Canada in 964, but nly 5 physicians brn in Canada entered the United States in that year (Table 4). It is clear that Canada is a "way statin" fr migratin t the United States. Spain is anther imprtant way statin. Frm Cuba, in particu- TABLE 4. PHYSICIANS ADMITTED TO THE UNITED STATES, BY COUNTRY OF BIRTH AND BY COUNTRY OF LAST PERMANENT RESIDENCE, SELECTED COUNTRIES AND REGIONS, 964 Number admitted Cuntry r regin Cuntry f Cuntry f birth last residence Ttal,49,49 Eurpe 56 6 Greece 44 Spain 9 8 Turkey 5 9 United Kingdm Asia 5 4 Canada 5 44 Mexic 6 77 Cuba 4 9 Suth America All thers 9 57 Surce: Direct infrmatin, U.S. Department f Justice, Iminigratin and Naturalizatin Service. f-

21 lar, many migrants are entering the United States after residing in ther cuntries. Mst physicians migrating t the United States frm Mexic and Suth America were brn there. The part f the migratin accunted fr by physicians nt brn in Suth America wh mve t the United States after residing in Latin America in quite small. In general, Suth America and Mexic are nt imprtant way statins. On the cntrary, mst persns wh migrate t Mexic and Suth America frm Eurpe and elsewhere stay in thse cuntries and d nt migrate again t the United States... Migratin within Latin America There is n questin that there are substantial mvements f highly trained peple within Latin America, but the absence f statistics leaves nly impressins, experience, and infrmed judgments t g by. Frtunately, hwever, these impressinistic views are quite adequate t describe the majr mvements. The mst significant mvements f skilled peple in Latin America take place within the cuntries rather than frm ne cuntry t anther. Every natin has prblems arising frm the mvement f peple t majr cities, usually the capital. The mst carefully studied aspect f this situatin is the distributin f physicians between rural and urban areas in Latin America. Physicians gravitate t the big cities t such a degree that the prvisin f medical services t rural areas has becme an exceedingly difficult prblem. On the average, there are five times as many physicians in capitals and large cities as in the remaining areas f the cuntries, r 5 per,, as against per,.8 In the individual cuntries the urban rati is anywhere frm three t twenty times as great as the rural rati. Scientists tend t cluster arund universities, and the largest and mst prestigius universities are fund in the largest cities. Mrever, pprtunities fr supplemental incme are generally best in large cities. As the seat f natinal gvernments, capital cities are the lcus f plitical pwer and generally the center f the cultural life as well. They tend t hld a particular attractin fr scientists, engineers, physicians, and ther highly trained peple. The cuntry-t-city, pr-area-t-rich-area internal migratin that is typical f Latin American cuntries can be illustrated by the case f Mexic: The available data n the extent and directin f internal migratin during the perids f refrm and rapid industrializatin indicate that a grwing number f Mexicans have been migrating frm the villages t the cities, frm smaller t larger cities and frm dry t irrigated land. They have fresaken less develped areas with few pprtunities fr the mst develped areas with greater prspects fr further develpment. Of equal imprtance is the nature f the migrants arriving in the mre advanced areas. It is likely that many graduates with middle and higher educatin frm the less advanced states are nw living utside them. Upn cmpletin f each phase f their educatin, ambitius students are ften frced t migrate in rder t pursue further study and later t find emplyment pprtunities cmmensurate with their level f educatin, as well as living standards ptentially equal t their expectatins. Primary graduates in rural areas must migrate t larger twns t attend secndary schl and smetimes t cities t attend preparatry schl. University educatin f high quality and diversity ften necessitates travel t the Federal District, and nce having left the prer states, many students d nt return. 9 Just as internatinal migratin is caused by basic differences between ne cuntry and the next that are difficult t change, s, t, the special situatin f large cities is brught 8 Pan American Sanitary Bureau, Health Cnditins in the Americas, (prepared fr the XV Meeting f the Directing Cuncil), Washingtn, D.C., 964, p. 6. (Scientific Publicatin N. 4) 9 C. N. Myers, Educatin and Natinal Develpment in Mexic, in Harbisn and Myers (eds.), Manpwer and Educatin; Cuntry Studies in Ecnmic Develpment, New Yrk, McGraw-Hill, 965, Pp

22 abut by pwerful histrical frc:es whse cn- England than frm any single Latin American sequences are nt easily altered. Bth prblems cuntry. In all, 4 Eurpean cuntries are must be dealt with in the cnte: xt f ttal na- represented by the scientists wh have mved tinal develpment-scial, cultural, and ec- t Venezuela. nmic. Indeed, mre scientists have been at- frm ne tracted t Venezuela frm Eurpe than frm Migratin f prfessinal peple cuntry t anther within Latiin America is elsewhere in Latin America. Tw reasns fr substantial. The mst significant rnvement is t this are that there are many mre scientists in Venezuela, whse prsperity and rapid grwth Eurpe than in Latin America and that cn- n the ditins fr scientific wrk in many Eurpean rate are key factrs. Persnal inicmes, average, are the highest in L.atin America. cuntries have nt been the best in the wrld. Incmes fr scientists, engineers, and physicians The case f Venezuela is particularly instrucare sufficiently generus t attrat.ct many excel- tive because it illustrates the pwerful influence lent peple frm Western Eurpee. Indeed, the f mney. The ability f Venezuela t attract mnthly salaries f scientists engaged full time scientists can be primarily attributed t her rich in research in Venezuela are extrardinarily endwment f petrleum. But general prsperity alne was nt enugh. Venezuela has high: had Mnthly salary (apprximate U.S. dllar equivalent) Over Percentage f scientists There are abut 75 scientists in Venezuela. Of these, apprximately per cent are freigners and anther 7 per cent are naturalized citizens. In the first grup, freigners wh have migrated but wh have nt becme naturalized citizens, abut 5 are frm Latin America, 8 frm Eurpe, and 5 frm elsewhere. Spain has supplied the largest number-abut 5- and Argentina the next-abut 5. Other Latin American scientists have cme frm Peru, Brazil, Blivia, Chile, Clmbia, Csta Rica, Cuba, Ecuadr, Mexic, and Uruguay. Still, mre migrants have cme frm Italy and frm Bases para la Creación de un Cnsej Nacinal de Investigacines Científicas y Tecnlógicas en Venezuela; Infrme que Presenta la Cmisión Preparatria Designada al Efect, Caracas, Juni 964. t take specific steps t ensure high salaries fr scientists. While Venezuelan salaries are very high by Latin American standards and high by Eurpean standards, they are nt high 6 by U.S. standards. Thus, it is nt necessary 7 fr the Latin American cuntries t match... 4 U.S. salary levels in rder t keep their pr-.. fessinals at hme and t attract migrants frm... 7 ther cuntries.... T'Mr- mnlres ::: F>m»"- ^_ cri-c--c- kuic. ID Il U.IUIi:{kU UVUIIiUilL[ MbUCII{.l. amng ther Latin American cuntries, mst ntably t Mexic, but this flw is nt large enugh t raise questins f natinal plicy.. Mvement by Cuntry-Numbers and Rates The Latin American cuntry mst adversely affected by migratin in recent years has been Cuba, primarily as a cnsequence f unique plitical circumstances. Apart frm Cuba, the tw cuntries with the largest number f emigrants have been Argentina and Clmbia. In bth f them, the number f emigrants remained fairly level in the 5-t-5 range frm 959 thrugh 96, but it tk an upward turn in 96 and had increased t nearly, frm Argentina and 9 frm Clmbia by 965 (Figure and Table 5). i

23 FIG.. PROFESSIONAL, TECHNICAL, AND KINDRED WORKERS ADMITTED AS IMMIGRANTS TO THE UNITED STATES, FROM SELECTED COUNTRIES OF THE AMERICAS, , - AR( 55U ECUADOR PERU -- -BRAZIL -L----EI - - BOLIVIA CHILE O YEARS The situatin f Clmbia is abut three times as difficult as that f Argentina. In the first place, per capita grss natinal prduct in Clmbia is nly abut half f that in Argentina-apprximately $ as cmpared t apprximately $6. Therefre, fewer resurces are available t make fr the kind f cnditins that will attract and hld prfessinal peple. In the secnd place, althugh Clmbia's ppulatin f 5 millin is abut 7 per cent f Argentina's millin, the base f prfessinal peple is much smaller. Clmbia has 5 physicians fr every, peple, whereas Argentina has abut 5 per,. Clmbia has nly abut 7, engineers, whereas Argentina has abut,. Generally speaking, Argentina has a skilled, prfessinal manpwer base abut three times as large as that f Clmbia. Thus, the lss f a single persn is abut three times mre serius t Clmbia than it is t Argentina. Sme f the cuntries with a lw level f ut-migratin still have prblems, hwever. Ecuadr and Brazil prvide an interesting cntrast in this regard. Every year ver the last decade abut the same number f prfessinal and related persns have migrated t the United States frm bth cuntries. The trend f migratin frm each cuntry has risen mderately but steadily. Hwever, Brazil has mre than 5, physicians and 5, engineers, whereas Ecuadr has fewer than, in each f these categries. Brazil and Ecuadr have rughly the same rati f physicians t ppulatin, but the ttal ppulatin f Brazil is apprximately 8 millin, whereas that f Ecuadr is nly abut 5 millin. The per capita grss natinal prduct in each f the tw cuntries is rughly $, but Brazil has a number f imprtant ecnmic and cultural centers where

24 TABLE 5. PERSONS ADMITTED TO THE UNITED STATES WITH IMMIGRANT VISAS, FROM SOUTH AMERICA, ARGENTINA, AND COLOMBIA, SELECTED PROFESSIONS, 965 Prfessinal grup Suth America Argentina Clmbia Ttal, all prfessinals, Chemists 6 6 Prfessrs (all kinds) Physicians Engineers, ttal Civil 49 Electrical 8 5 Mechanical 6 6 Other Bilgists and agricultural scientists 9 6 Mathematicians and physicists 9 4 Nurses 4 58 Ecnmists 9 4 Teachers, ttal Technicians, ttal 84 5 Medical Electrnic 4 7 Scientific 4 Other Surce: Direct infrmatin, U.S. Department f Justice, Immigratin and Naturalizatin Service (see Appendix II). incmes are well abve the natinal average. Clearly, when an equal number f prfessinals migrate frm each cuntry, Ecuadr suffers a much mre serius lss than des Brazil. Blivia and Chile are anther example. Rughly the same number f prfessinal persns migrate frm each f the cuntries. But Chile has mre than 8 millin inhabitants, whereas Blivia has abut 4 millin. The per capita grss natinal prduct is apprximately $5 in Chile and abut $5 in Blivia. Chile has abut 5, physicians; Blivia, abut,. Thus, the migratin f prfessinal persns is a far mre serius matter fr Blivia than it is fr Chile. In terms f per millin inhabitants, migratin frm Csta Rica, the Dminican Republic, Haiti, and Trinidad and Tbag is particularly significant, even thugh the abslute numbers f migrants are small (Figure ). The tw Suth American cuntries mst affected by migratin are Ecuadr and Clmbia, with Argentina in third place. Mexic, Chile, and Venezuela are in an intermediate FIG.. POTENTIAL) LOSS OF PROFESSIONAL AND TECHNICAL WORKERS, BY COUÑTRY, ) LATI AMERICA CDSTA RiCA MINICAl REP. LATIN AMERICA, 965 (Immigrant Visas t the U.S. per Millin Ppulatin) 4 6 8, , i MEIC TRINIDAD AiO TOAlGO GUATEMALA ECUADOO COOMBIlJ ARGENTUN Cxiif lwuezueu PERi URUGUAI 88iZ~ A sulbrtltl p.,erceta f thse wh bin ira Vt v.isas w ii return EI-dclArg Cb. Visas pe milin ppulitin fr Cba were. 4

25 psitin. Peru, Uruguay, and Brazil-particularly Brazil-lse relatively few highly trained peple..4 Migratin by Occupatinal Grup Migratin f highly trained persns is nt cncentrated in any specific ccupatinal field. Cuntries frm which large numbers migrate lse many peple in all prfessins. Fr example, Argentina, Clmbia, and Mexic have lst the largest numbers in all f the majr skilled grups. (Mre prfessrs have entered the United States frm Clmbia, hwever, than frm any ther Latin American cuntry.) By and large, the factrs giving rise t migratin are cmmn t all fields. The basic issues in Latin America d nt, as in sme ther parts f the wrld, relate t the establishment f pririties amng the different scientific fields, allcatin f resurces t the varius disciplines, r the like; rather, they pertain t the peratin f the ttal sciety and ecnmy and t the emphasis placed n science and higher educatin as cntrasted with ther imprtant areas f activity. 5

26 , MIGRATION BY PROFESSION. Physicians Every year abut physicians migrate frm Latin America t the United States.l This number is equal t the annual utput f three large U.S. medical schls. It wuld cst at least $6 millin t build three teaching medical centers and mre than $5 millin a year t perate them. In these terms, the value f the physicians cming t the United States is rughly equal t that f all U.S. medical assistance t Latin America. Migratin f Latin American physicians t the United States was uncmmn befre 95, but in recent years the rate has increased prgressively. Between 956 and 96 a ttal v The number wh enter with an immigrant visa is a firm figure. The number f these wh actually migrate is an estimate. See Chapter 4 fr a full discussin f the data presented in this summary. FIG. 4. PERSONS ADMITTED TO THE UNITED STATES WITH IMMIGRANT VISAS FROM LATIN AMERICA, SELECTED COUNTRIES AND OCCUPATIONS, 965 ARGENTINA MEXIC COLOMBIA BRAI PERt ECUADO CHILE IM [] N U Ba E R U I I I I I I I r I I I I I I I~~~~~ PHYSICIANS ARGENTINA NIEXICgOi~ COLOMBIA ECUADOR BRAZIL CHILE PERU as gzlai 6I96 TEACHERS ALL TYPES ARGENTINA COLOMBIA MEXICO BRAZIL CHILE PERO ECUADOR il zqzm ENGINEERS ALL KIOS ARGENTINA COLOMBIA MEXICO ECUADOR CHILE BRAZIL PERU I Xl TECHNICIANS a MEDICAL A all TYPES COLOMBIA ARGENTINA EMEROM COLOMBIA BRAsIL MEXICO PERU CHILE ECUADOO m= m m m a PROFESSORS ALL TYPES MEXICO ARGENTINA ECUADOR BRAIL PERU m=""""""""""""""""""" NURSES CHILE 6

27 f,765 physicians wcere admitted t the United States with immigrant visas frm Latin America (nt including Cuba) ), whereas frm 96 t 965 sme,5 wcere admitted. Their dis- As in the case f prfessinals in general, the migratin f physicians t the United States des nt pse as severe a prblem t the Latin American cuntries as it des t certain tributin by majr gcegraphical areas was as fllws: cuntries in ther parts f the wrld. Fr Area Ttal Mexic Central America Suth America example, as many physicians migrate annually t the United States frm the Philippines as frm all the cuntries f Suth America cm- Ttal bined. As many physicians migrate t the 4,57,74,55 United States frm Turkey as frm Argentina, but Turkey nly prduces a third as many physicians each year as Argentina des and,79,56,65 has nly ne furth as many physicians in relatin t ttal ppulatin. Mst physicians wh have immigrated entered the United States as interns r residents. There are currently abut, interns and residents in the United States wh are graduates f Latin American schls. Of the,77 graduates f Latin American medical schls in the United States wh are nt interns r residents, apprximately, are frm Cuba, 9 frm Mexic (abut ne third f these are U.S. citizens), 99 frm Argentina, 94 frm the Dminican Republic, frm Clmbia, 86 frm Peru, and frm Brazil. The 965 rate f immigratin represents abut 5 per cent f the annual utput f all medical schls (excluding the Cuban schls) in Latin America. If Cuba is included, the prprtin ges up t 8 per cent. T appreciate the magnitude f this trend, the situatin may be imagined in reverse: What wuld happen in the United States if every year a cmparable prprtin f the annual U.S. utput-between and 5 physicians-were t migrate t Latin America? An acute reactin indeed culd be expected. Apprximately 5 per cent f thse physicians wh are ptential scientists and teachers are being lst t Latin America by migratin t the United States. Prbably as many as highly trained Latin American physicians in the United States wuld return t their cuntries t pursue academic careers if suitable pprtunities were available. 7 Of the physicians wh migrate t the United States frm Latin America, three ut f every fur cme frm Argentina, Clmbia, Mexic, and Peru. Mrever, three ut f fur migrants cme frm eight Latin American medical schls: Argentina Natinal University f Buens Aires Natinal University f Córdba Clmbia Natinal University f Bgtá Dminican Republic University f Sant Dming Haiti University f Haiti Mexic Natinal University f Mexic University f Nuev León Peru San Marcs Natinal University Six f these universities (all except the Natinal University f Córdba and the Natinal University f Bgtá) accunted fr almst 6 per cent f thse wh migrated in 96. As backgrund fr these data, it is useful t bear in mind that 8 per cent f all Latin t Appendix VI gives detailed infrmatin n the current status f graduates nw in the United States frm these tw universities.

28 American physicians cme frm six cuntries- enjy a very high scial status. Thus, many Argentina, Brazil, Clmbia, Cuba, Mexic, have a clear mtive t migrate, particularly t and Venezuela-and that tw thirds are pr- the United States where wages and wrking duced by Argentina, Brazil, and Mexic alne. cnditins are relatively gd. But there are The effects f migratin n irndividual many factrs that inhibit migratin as well. A cuntries depend nt nly n the nurmber but number f nurses belng t religius rders and als n the prprtin f physicians leaving. are cmpletely dedicated t their wrk in their Annual migratin in relatin t annnual pr- hme cuntries r ther Latin American cun- ductin f new physicians as is estinnated tries. Wmen ften have very strng family fllws fr the perid : ties, and the prspect f migratin pses a frbidding persnal and cultural change. Als, Migrarnts many f them d nt have the kind f training Area and as a perceentage required fr easy emplyment in the United cuntry f gradu ates States. Frequently they d nt speak English. Ttal 5 Jbs are available in the United States fr Mexic... 8 well-trained Latin American nurses wh have Central America... an adequate cmmand f English.'5 Salaries, Suth America Argentina... wrking cnditins, and status are all mre Clmbia. 6 favrable, ften markedly s, than in the Latin American cuntries. The yearly salary f the Fr cuntries that have relatively few phy- average registered nurse in a nnfederal metrthrugh sicians, the lss f even a small numbei plitan hspital is $4,5. Thus, the United migratin can generate serius diifficulties. States ffers strng attracting frces fr nurses. Smaller cuntries having a high rate cf migra- The migratin pattern f nurses varies widely tin are the fllwing: frm ne cuntry t anther. Of the 5 Latin American nurses admitted t the United Migran*ts States with immigrant visas in 965, almst as a perce LIL48V Cuntry f graduates 6 per cent came frm seven cuntries- Argentina, Clmbia, Csta Rica, Cuba, the Dminican Republic... 4 Dminican Republic, Ecuadr, and Mexicwhereas nly a few came frm Blivia, Brazil, Haiti C Nicaragua... E Chile, and Peru (Table 6). In mst Latin American cuntries the migratin. Nurses 4 f nurses is nt a serius prblem, but in a few f them, specifically nted belw, the Nurses thrughut Latin America difficult ecnmic and scial psitin, are in a and this situatin is cause fr cncern. is the primary cause f migratin. Sallaries are 5 "Natinal Crisis in Nursing," Medical Wrld lw; wrking cnditins are ften un pleasant; News, January, 966. The shrtage f nurses in pprtunities fr advancement are quite pr; the United States appraches a crisis stage. This and jb stability is smetimes affeected by shrtage arises frm tw primary sets f factrsthse affecting the supply f nurses and thse affecting the demand. The supply is restricted by such plitical changes. Mrever, nurses d nt factrs as lw salaries relative t thse available t 4 The Zne Offices f PAHO, fficials f Latin American gvernments, the central nursingg ffice f PAHO, and the American Nursing Assciatin kindly cperated in supplying data fr this sect:in. girls in ther ccupatins, relatively unfavrable wrking cnditins, and marriage. Demand is high because f rising standards f medical care, rising demand fr medical care, and increases in the range f services prvided by nurses...{ 8

29 TABLE 6. NURSES AND MEDICAL TECHNICIANS FROM LATIN AMERICA ADMITTED TO THE UNITED STATES WITH IMMIGRANT VISAS, 965 Medical Cuntry Nurses technicians Ttal 5 74 Mexic 45 Cuba Dminican Republic 8 6 Haiti 7 7 > Trinidad and Tbag 8 5 Central America 8 I Canal Zne - Csta Rica 6 4 El Salvadr 4 Guatemala 5 Hnduras 5 Nicaragua 7 Panama 7 British Hnduras 7 Suth America 6 Argentina 4 8 Blivia Brazil 9 4 Chile 7 8 Clmbia 58 9 Ecuadr 8 Paraguay - Peru 8 Uruguay - Venezuela 8 Other 6 Surce: Direct infrmatin, U.S. Department f Justice, Immigratin and Naturalizatin Service (see Appendix II). Blivia: Of the 464 graduates f the principal nursing schls, 4 (r 4 per cent) have migrated: Ttal 4 United States Latin America... 9 Peru Venezuela... Brazil... 6 Other... 4 Other... 6 Chile: Migratin f nurses is a significant prblem in this cuntry. The nurses frm the best schls are very well trained and are highly regarded in the United States. Clmbia: Accrding t an imprtant study nw in prgress, there are abut, active nurses in the cuntry. 6 Abut per cent (6) have migrated t the fllwing areas: Ttal United States... Latin America... Venezuela... Panama... Ecuadr... Other... Eurpe... Other (Canada and Cng) Ecuadr: Of the 44 living graduates f the Natinal Schl f Nurses, 78 (9 per cent) have migrated-47 t the United States and t ther Latin American cuntries. Hnduras: Abut per cent f all nurses migrate, mstly t the United States. Jamaica: This cuntry has a serius migratin prblem. Abut nurses graduate annually, but sme nurses trained in Jamaica apply fr wrk abrad each year. 7 The facts n migratin f nurses d nt bear ut certain widely held assumptins. Fr example, althugh it is ften assumed that migratin f nurses is a general prblem, many cuntries lse very few nurses this way. As anther example, the migratin f nurses frm Chile has been widely publicized, but Clmbia, Peru, and Ecuadr all lse mre nurses by migratin than des Chile.. Engineers and Scientists In 965 a ttal f 574 Latin American engineers were admitted t the United States with immigrant visas (Table 7). The figures n engineer migrants tend t be high. In the first place, unlike the case f 6 Preliminary data frm a study f health manpwer and medical educatin in Clmbia. 7 'What Happens t Jamaica's Trained Nurses?" The Jamaican Nurse, Dec. 964, p. 8. 9

30 TABLE 7. ENGINEERS FROM LATIN AMERICA ADMITTED TO THE UNITED STATES WITH IMMIGRANT VISAS, 965 Cuntry Ttal Civil Electrical Mechanical Other Ttal Mexic Cuba Dminican Republic 6 Haiti Trinidad and Tbag Central America 5 6 Csta Rica 4 El Salvadr Guatemala 7-4 Hnduras 7 Nicaragua 5 5 Panama British Hnduras 4 Suth America Argentina Blivia Brazil Chile Clmbia Ecuadr 4 6 Paraguay Peru 7 9 Uruguay Venezuela rz f e Surce: Direct infrmatin, U.S. Department f Justice, Immigratin and Naturalizatin Service (see Appendix II). scientists and physicians, all persns wh call themselves engineers are nt knwn fr certain t be prfessinally trained engineers with university degrees. In the secnd place, nt all f thse wh enter with immigrant visas actually migrate. Apart frm Cuba, with 9 migrating engineers, fur cuntries accunt fr mre than half f the migrating grup-argentina (84), Clmbia (7), Mexic (57), and Brazil (7). In the absence f data n ttal engineers r annual graduates in each cuntry, a rugh migratin rate was estimated by cmputing the number f engineer migrants per millin ppulatin (Figure 5). This apprach, althugh it is admittedly far frm satisfactry, shws the greatest relative lsses fr Trinidad and Tbag, Csta Rica, Haiti, the Dminican Republic, Brazil, and Clmbia, in that rder. The number f engineers migrating frm Latin America as a whle is nt large enugh t getnerate serius prblems. There are several reasns fr this. Engineering training in Latin America is typically riented tward lcal prblems. The backgrund required fr the practice f engineering in Latin America is generally different frm that required in the United States. The demand fr lcally trained engineers is typically very high in Latin American cuntries, and salaries are relatively gd. In many cuntries, engineers are needed bth in private industry and in gvernment. Many engineers mve frm technical psitins t general managerial psitins. Relatively fewer engineers than physicians and scientists speak English. Fr the mst part, engineers in Latin America are fully trained when they graduate frm the university after a fur- r five-year curse.

31 FIG. 5. POTENTIAL Lss OF ENGINEERS BY COUNTRY, LATIN AMERICA, 965 * (Immigratin Visas t the U.S. per Millin Ppulatin) LATIN AMERICA MEXICO TRINIOAD AND TOBAGO,r COSTA RICA fl HAITI DOMINICAN REP. GUATEMALA BRAZIL COLOMBIA ARGENTINA CHILE ECUADOR VENEZUELA PERU URUGUAY J I 5 5 I * nmnths Oding jue, 965 *. ERxldinl Cuba. RaDe DaD Cuba *as A They usually require n further wrk in rder t accept jbs and begin their careers. Only in Mexic is graduate wrk in engineering cmmn. In cntrast, the persn wh aspires t a career as a scientist has cmpleted nly his basic training when he graduates frm the university, either frm a faculty f philsphy in sciences r frm medical schl. Much further graduate wrk is required befre he is able t assume even the apprenticeship phases f fulltime investigatr wrk. Often, if nt typically, this graduate wrk must be dne abrad. Scientists tend mre than engineers t be members f an internatinal cmmunity. They are trained in an atmsphere where the internatinal mvement f peple is a nrmal and expected phenmenn. Scientific wrk itself is nt as clsely bund t lcal cnditins as is engineering. T a greater degree than is true in engineering, peple wrking n the same prblem are fund in different cuntries. The training f scientists is such that they can mve with relatively little disruptin f their wrk. In Latin America their skills are usually nt in as high demand as thse f engineers. Psitins fr scientists are restricted almst entirely t teaching and research psts in universities and research institutes. In general, they d nt have the recgnitin and prestige accrded t physicians and engineers. Gd scientists are eagerly sught by labratries in the United States. A relatively high prprtin f Latin American scientists, particularly in recent years, have btained part f their advanced training in the United States, and mst f them speak English. Still, the number f scientists migrating frm Latin America is small cmpared t the utflw f engineers and physicians. The small figure may be partly attributed t the fact that sme scientists list themselves as "prfessrs" rather than "scientists." But the number f prfessrs wh migrate is als small, s the general prpsitin that few scientists migrate remains valid. The main reasn fr the lw migratin rate amng scientists is that few f them exist. The prfessinal scientist-a persn with a Ph.D. degree r its equivalent wh is engaged full time in research r in a cmbinatin f research and teaching-is quite new n the Latin American scene. Cnsequently, the migratin f a small number f scientists means the lss f a significant prprtin f the ttal number in a cuntry..4 Nnmigrants Away frm Hme- Students and Internatinal Civil Servants Students and internatinal civil servants spend time utside their wn cuntries, althugh mst f them return and are therefre nt migrants. Their case is f particular interest here because study abrad r service in internatinal rganizatins is ften a prelude t migratin. Mrever, such activities abrad tend t aggravate shrtages f highly trained peple in the hme cuntry.

32 .4. Latin American students in the United States In 964 the students frm Latin America studying in the United States numbered 9,4, graduate students accunting fr,8 f the ttal (Table 8).8 Almst 4 per cent f the TABLE 8. LATIN AMERICAN STUDENTS IN THE UNITED STATES, BY FIELD OF MAJOR INTEREST, 964 Field Number Percentage Ttal 9,4 Agriculture Business administratin 956 Educatin 7 Engineering,5 Humanities,5 4 Medical sciences Physical and natural sciences,58 Scial sciences,56 4 All ther 8 N answer 68 Surce: Institute f Internatinal Educatin, Open Drs, 965, New Yrk, 965. ttal grup were studying engineering, physical r natural sciences, r medical sciences. Fr every student in the medical sciences there were 8 Institute f Internatinal Educatin, Open Drs, 965; Reprt n Internatinal Exchange, New Yrk, 965. tw in the physical and natural sciences and fur in engineering. Mst students are nt migrants. They study in the United States and return t their hmes. Fr these students, study in the United States cnstitutes an imprtant persnal gain and als a significant additin t the human resurces f their native cuntries. Fr the United States, the thusands f Latin American students in attendance at universities prvide the means fr establishing a cultural bridge t Latin America. Student training prgrams, imprtant as they are t Latin American cuntries, have a hidden cst in the later migratin f sme f the students. The pprtunity t learn English, t becme accustmed t the culture f the United States, and t becme acquainted with jb pprtunities ften makes later migratin seem mre feasible and desirable. Infrmed persns in bth Latin America and the United States agree that thse wh visit the United States t study with their wn funds mre ften migrate than thse whse study is made pssible by fellwships either frm their wn cuntries r frm the United States. The best available figures shw that fewer than ne per cent f the students wh have studied in the United States with the aid f gvernment funds have returned as migrants t the United States. This is lgical, since thse wh study TABLE 9. PERCENTAGES OF GRADUATE STUDENTS IN SELECTED FIELDS OF SPECIALIZATION, IN SEVEN LATIN AMERICAN COUNTRIES, Percentage in given specialty Number f Public admin. Cuntry students and plitical Engineering Agriculture* Ecnmics sciences Humanities Ttal, Brazil Mexic Clmbia Venezuela Argentina Chile Peru Surce: Institute f Internatinal Educatin, Open Drs, 965, New Yrk, 965. * Includes all six agricultural specialties: agriculture, agrnmy, agricultural engineering, fd technlgy, husbandry. and veterinary medicine.

33 with the aid f gvernment fellwships usually have a mral bligatin t return, and sme effrts have nrmally been made t design the training fr emplyment at hme in a preselected field where jbs exist. Thse wh cme with the aid f private funds, n the ther hand, are freer t remain in the United States and may nt necessarily have assurance f a psitin t which they can return. There are disparities b.between natinal needs ~ and the current distributin f students (Table 9). During the academic year in seven imprtant cuntries nly 9 per cent f the graduate students were studying agricultural specialities r ecnmics, nly per cent were studying public administratin and plitical A sciences, abut per cent were studying engineering, and almst 5 per cent were studying humanities. The maldistributin f students is a majr prblem in itself, but it is als related t the questin f migratin. A mre deliberate effrt n the part f the Latin American cuntries with the aid f the United States t adjust training patterns t high-pririty natinal needs shuld help t keep highly trained persns in their hme cuntries..4. Internatinal civil servants The number f highly trained and talented citizens emplyed by internatinal rganizatins is cause fr cncern t sme Latin American cuntries. In 964 mre than 8 Latin American prfessinal and technical persns recruited internatinally were serving with such TABLE. LATIN AMERICAN CITIZENS RECRUITED INTERNATIONALLY FOR INTERNATIONAL AGENCIES, 964 Cuntry Ttal FAO UN WHO UNESCO ILO OAS IAEA PAHO ICAO ITU WMO Ttal Argentina Blivia Brazil Chile Clmbia Csta Rica Cuba Dminican Republic 9-4 Ecuadr El Salvadr Guatemala Haiti Hnduras Jamaica - 8 Mexic Nicaragua Panama Paraguay Peru Trinidad and Tbag 7 - Uruguay Venezuela Surce: Direct infrmatin, U.S. Department f State. FAO-Fd and Agriculture Organizatin w UN-United Natins WHO-Wrld Health Organizatin UNESCO-United Natins Ecnmic, Scientific and Cultural Organizatin ILO-Internatinal Labr Organizatin OAS-Organizatin f American States IAEA-Internatinal Atmic Energy Agency PAHO-Pan American Health Organizatin ICAO-Internatinal Civil Aviatin Organizatin ITU-Internatinal Telecmmunicatins Unin WMO-Wrld Meterlgical Organizatin

34 rganizatins (Table ). N details by ccupatin are available, but it is knwn that the grup is cmpsed almst entirely f highly qualified persns whse services are needed at hme as well as by internatinal rganizatins. Wrk abrad des nt necessarily mean migratin; mst persns wh serve in internatinal rganizatins g back t their cuntries. In the lng run the cuntries benefit frm the experience. The persns wh serve abrad ften return better trained t wrk lcally. Als, natinal prestige tends t be enhanced. Hwever, sme individuals becme permanent career emplyees in internatinal rganizatins, and hence migrants. The size f the grup is nt knwn, but a quarter f the ttal is a reasnable estimate. If this guess is dse, then the cst f prviding staff fr internatinal rganizatins is nt serius fr the Latin American cuntries, even thugh exceptinally able executives are always needed at hmé. Tw thirds f the Latin Americans recruited internatinally wrk fr FAO, the UN, r the OAS, and the remainder are scattered amng all f the majr internatinal rganizatins (Table ). The cntributins f varius cuntries t the staffing f internatinal rganizatins are nt unifrm. Abut 6 per cent (5) f all internatinal staff members emplyed as f 964 were frm six cuntries: Argentina, Brazil, Chile, Clmbia, Cuba, and Mexic. Each f these cuntries cntributed 6 r mre emplyees (Table ). In terms f natinal representatin, there are sme interesting differences. Peru, fr example, has mre than fur times as many internatinal emplyees as des Venezuela. Chile's cntingent is almst as large as that f Brazil. Argentina has nearly twice as many citizens in internatinal rganizatins as des Mexic, whereas Mexic and Clmbia have just abut the same number. The reasns fr these differences are nt clear. Perhaps the relative prsperity f Mexic and Venezuela makes wrk with internatinal rganizatins less attractive t citizens f these cuntries. The quta system tends t make prprtinately mre jbs available t citizens,d f smaller cuntries. Natinal traditins affect the degree f participatin in internatinal affairs. These are all cntributing factrs, t be sure, but they prbably d nt accunt entirely fr the disprprtins that exist. TABLE. LATIN AMERICAN CITIZENS RECRUITED INTERNATIONALLY FOR INTERNATIONAL AGENCIES, REPRESENTATION BY GROUPS OF COUNTRIES, 964 Surce: Cuntry Ttal Argentina Brazil Chile Ttal Mexic Clmbia Cuba Ttal Haiti Peru Ecuadr Ttal Blivia Uruguay Csta Rica Ttal Panama El Salvadr Guatemala Ttal Paraguay Trinidad and Tbag Jamaica Ttal Venezuela Dminican Republic Nicaragua Hnduras Ttal Number Direct infrmatin, U.S. Department f State

35 4. THE SPECIAL CASE OF PHYSICIANS s Because f the magnitude and significance f the migratin f physicians t the United States frm Latin America and because f the special interest f the Pan American Health Organizatin in this prfessin, a particularly detailed study has been made f this mvement. The data presented belw summarize infrmatin frm all knwn surces and include material cllected especially fr this investigatin. 4. Backgrund The large-scale migratin f physicians frm Latin America t the United States is a very recent develpment. In early 966 there were,77 graduates f Latin American medical schls in the United States (excluding interns and residents); f these, hwever, nly `' 8 had graduated prir t 94, and abut half f these 8 were Cubans wh had mis grated recently (see Appendix VII fr a special nte n Cubans). The rate f migratin began t rise sharply arund 95 and has increased prgressively. Tward 96 there was a slw- ing f the rate f increase, but the upward trend has cntinued (Figure 6). It shuld be nted, hwever, that a substantial prtin f thse wh enter the United States with immigrant visas d nt stay permanently in the United States, as will be explained belw. ' Anther measure f migratin is the number f U.S. medical licenses issued by examina- ", tin t graduates f Latin American schls. Licenses issued t graduates frm schls in Mexic, Argentina, Clmbia, and Peru shwed an increase during the years 96 thrugh 964 (Figure 7). Althugh t sme extent these data suggest rates f migratin smewhat higher than were actually the case, they still reflect the recent trends fairly well. Excluding Cuban graduates, 5 graduates f Latin American schls btained U.S. licenses by examinatin in 96. The annual figure in 964 was 45. In the last several years abut,5 Cubans have migrated t the United States. An analysis f data frm the American Medical Assciatin (AMA) in early 966 shwed that there were,78 Cuban graduates in the United States. Migratin frm Cuba represents a rather special, and t sme degree unique, FIG. 6. U.S. IMMIGRANT VISAS TO GRADUATES OF LATIN AMERICAN MEDICAL SCHOOLS, , 4 - r 8t J ( :.-, ' * *-'-* SbXi' B FIG. 7. U.S. LICENSES TO LATIN AMERICAN MEDICAL GRADUATES, e

36 situatin. The present reprt deals mainly with migratins frm ther Latin American cuntries. 4. Magnitude f Migratin In appraising the data presented here, it is useful t have certain facts in mind. T begin with, there are abut medical schls in Latin America, frm which apprximately 6,7 persns graduate each year. There are rughly 94, physicians in the United States, f whm abut 4, are interns and residents. As f early 966 there were 5,97 physicians in the United States wh were graduates f Latin American schls (rughly per cent f all U.S. physicians). Three furths f them came frm Cuba, Mexic, Argentina, and Clmbia (Table ). This number is equivalent t ne year's utput f all Latin American schls. Of the 5,97, abut, are interns and residents and rughly 5 are research trainees. Since 9 f the 5,97 are natives f the United States, the number f physicians in TABLE. GRADUATES OF FOREIGN MEDICAL SCHOOLs RESIDING IN THE UNITED STATES, 966* Cuntry Number Percentage Ttal 6, Cuba,8 Mexic,8 Argentina 78 Clmbia 54 9 Dminican Republic 4 7 Peru 5 Brazil 8 Haiti 8 Ecuadr 6 - Chile 6 Guatemala 6 Venezuela 6 Nicaragua 6 All thers f Surce: Direct infrmatin, American Medical Assciatin. * Figures have been runded ff. The actual ttal is 5,97 rather than 6.,. t Includes El Salvadr, Hnduras, Panama, Paraguay, Surinam, and Uruguay. 6 the United States wh are natives f Latin American cuntries is a little mre than 5,. Precise data are nt available n the number f Latin American physicians immigrating each year, but infrmatin frm several surces suggests that in very recent years the annual rate has been abut 55. If 5 Cubans are excluded, the annual immigratin rate f all ther Latin American physicians may be estimated at. This number represents rughly 5 per cent f the annual prductin f all Latin American schls. If Cubans are induded, the prprtin appraches 8 per cent. 4.. Difficulties in determining immigratin rates Attempts t determine rates f immigratin -that is, permanent change f residence withut regard t citizenship status-must take int accunt several cmplicating factrs. The number f immigrant visas issued is substantially higher than the number f immigrants. Based n sample surveys, there is evidence that as many as half f the physicians in the United States frm sme cuntries are pstgraduate trainees with immigrant visas wh d nt plan definitely t immigrate. Immigrant visas smetimes ffer fringe benefits, such as making it pssible t take back an autmbile when returning frm the United States. Als an immigrant visa may make it pssible t defer indefinitely the decisin t return r stay. In cntrast, trainees with visitr visas must leave the United States fr at least tw years immediately after their training is cmpleted. Occasinally waivers f this bligatin are granted, but the vast majrity f such requests are denied and mre than 9 per cent f Latin American physicians wh cme t the United States with visitr visas return t their wn cuntries. Fr statistical purpses, the U.S. Immigratin and Naturalizatin Service includes in their cunts f "immigrants" bth thse with immigrant visas and thse with permanent resident visas. Five years f residence in the United States is required befre U.S. citizenship can be btained. L Y.e (

37 Thus, persns with immigrant visas smetimes return t their native cuntries and ccasinally thse wh enter with visitr visas remain in the United States permanently. Even thse wh btain U.S. citizenship may eventually return, and sme f thse wh never becme U.S. citizens are immigrants in the sense that they are permanent residents f the United States. It is therefre impssible t predict with certainty wh will be a permanent resident., f the United States and wh will return. The precise immigratin figure fr 966, fr example, will nt be knwn fr many years. Accurate and final determinatin f immigratin rates can nly be made in retrspect. The number f U.S. licenses issued t Latin. American graduates is abut 5 per cent higher than the actual number f individuals wh btain licenses, since many dctrs get licenses i in mre than ne state. With respect t the natinal rigin f the licensees, the data available indicate nly the number frm each cuntry licensed by examinatin (see Appendix V). A great majrity are licensed by examinatin, but a lesser prtin, perhaps per cent, are licensed by the state licensure bards withut an examinatin. Althugh many f the states have reciprcity agreements, there are n natinwide licenses. Licenses must be btained frm the bard f the state in which the physician practices. A substantial number f Latin American graduates in the United States d research r ther similar wrk that des nt require licensure t practice medicine. Data n the number,~ wh d nt have licenses are incmplete. The figure f 5,97 graduates f Latin American schls given abve includes bth licensed and unlicensed physicians. The AMA census system identifies virtually all licensed physicians, b interns, and residents, and prbably mre than 8 per cent f the unlicensed physicians wh are graduates f Latin American schls. A small prtin, rughly t 5 per cent, f the graduates f Latin American schls wh are in the United States are natives f the United States. Abut half f them are graduates f the Natinal University at Mexic City. Many f these Mexic City graduates cme frm Puert Ric and return there after graduatin. Als, abut 5 per cent f the Latin Americans in the United States are nt natives f the cuntry in which they attended medical schl. 4.. Current rate f immigratin In 965 a ttal f 757 physicians frm Latin American cuntries were admitted t the United States as "immigrants" (Table ). Many were pstgraduate trainees wh had nt decided definitely t immigrate even thugh they held immigrant visas. Of this number, were Cubans and 556 were nn-cubans. Since many f the 556 may be expected t return t their native cuntries, the actual TABLE. PHYSICIANS ADMITTED TO THE UNITED STATES WITH IMMIGRANT VISAS, 965 Cuntry Number Ttal 757 Mexic Cuba Central America 98 Dminican Republic Haiti Trinidad and Tbag 7 Csta Rica 8 El Salvadr 6 Guatemala 6 Hnduras 5 Nicaragua 6 Panama 8 Suth America 48 Guyana* Argentina 4 Blivia 8 Brazil 7 Chile 8 Clmbia 8 Ecuadr Paraguay Peru 5 Uruguay Venezuela Surce: Direct infrmatin, U.S. Department f justice, Immigratin and Naturalizatin Service (see Appendix II). * Frmerly British Guiana. 7

38 annual immigratin rate fr nn-cubans is nt as high as these data suggest. As indicated abve, the annual rate f immigratin frm Latin America (excluding Cuba) is estimated at. 4. Characteristics f Migrants 4.. Cuntry and schl f immigrants Of all Latin American physicians in the United States, 8 per cent are graduates f just nine schls, althugh 7 f the Latin American medical schls have graduates in the United States (Table 4 and Appendix IV). The data n "ptential immigrants" (physicians entering the United States n immigrant visas) are mre meaningful when evaluated in the light f ttal ppulatins and numbers TABLE 4. LATIN AMERICAN MEDICAL SCHOOLS HAVING THE LARGEST NUMBER OF GRADUATES IN THE UNITED STATES, 966 Schl Number* % Cumulative % Ttal 77.. University f Havana, Cuba t Natinal University, Mexic City University f Sant Dming, D. R University f Buens Aires, Argentina San Marcs University, Lima, Peru Univ. f Nuev León, Mnterrey, Mexic Natinal University, Bgtá, Clmbia Natinal Schl f Medicine, Haiti University f Córdba, Argentina Fifty-eight ther schls Frty-six ther schls O - - Surce: American Medical Assciatin, census taken early in 966. * Des nt include interns r residents. t Estimate. f physicians prduced annually in the hme cuntries. Measured as the number f physicians per millin ppulatin, migratin rates fr the year ended June, 965, ranged frm.6 in the case f the Dminican Republic t.5 in the case f Brazil (Figur& 8). When "ptential immigrants" are shwn as an apprximate percentage f the annual number f graduates in the cuntry cncerned, the rate varies frm 6 per cent in Cuba t per cent in Uruguay (Figure 9). This latter percentage FIG. 8. POTENTIAL PHYSICIAN IMMIGRANTS TO THE UNITED STATES PER MILLION POPULATION, 965.7nLatín Amer.c,. DCminkicn Republic.6 Trinidad cnd Tbg 8.7 Blivia 8. P.nam. 7. Argentina 7. Csta Rica 6.6 Clmbi 5.8 HaiHi 4.8 Nicaragua 4. Uruguay.6 Ecuadr..5 Hnduras. El Salvadr. iper u.. Guatemala.4 IVenezuela. Chile. Prqtguay.5Braz I *excluding Cuba FIG. 9. POTENTIAL PHYSICIAN IMMIGRANTS TO THE UNITED STATES AS A PERCENTAGE OF ANNUAL OUTPUT OF PHYSICIANS, 965 Ltin Ameca Cuba 6 Hiti 48 Pn-m a I... Dminicn Republic 7 Nicaregun 7 Ecuadr El SIvadr Gutenlrl Clmbi 9 Hnduras 4 Mexic 8 Argentin 7Peu dvenezel. JChile Z Praguay u Urvguay 8

39 varies frm cuntry t cuntry, and statistics shw that in the case f sme cuntries less than 6 per cent f thse with immigrant visas will eventually migrate. Nevertheless, these figures make it pssible t crudely estimate fr each cuntry the extent t which immigratin cnstitutes a drain r a ptential drain n manpwer. 4.. Lcatin within the United States Fr the mst part, the graduates f Latin American schls are widely scattered thrughut the United States. Mre are fund in New Yrk than in any ther state, but even s, they are nly 96, r per cent f the,47 ttal (nn-cubans wh are nt interns r residents). There are tendencies fr the graduates f sme schls t cngregate in certain states. Of 94 graduates f the University f Sant Dming, 67 are in New Yrk and 79 are in Puert Ric. Out f a ttal f 59 Latin American graduates in Puert Ric, 5 are frm the Natinal University f Mexic City; Illinis has f the 76 graduates f the Haitian medical schl; and Texas is the hme f 84 f the 85 graduates f the University f Nuev León in Mnterrey, Mexic. Apart frm these instances, hwever, there are n ther ntable cngregatins f Latin American graduates within the United States. 4.. Citizenship status Data n the citizenship f Latin American physicians in the United States are incmplete. Infrmatin based n an AMA sample survey indicates that rughly half f the Latin American graduates in the United States (interns and residents excluded) are naturalized U.S. citizens. Mst f thse wh graduated befre 95 have changed citizenship and mst f thse wh graduated after 955 have nt becme U.S. citizens Prfessinal activities and specialties The general type f prfessinal wrk is knwn fr,47 Latin American graduates in the United States (nn-cubans wh are nt interns and residents). Analysis f 966 data supplied by the AMA shws that 86 ( per cent) are full-time specialists in private practice, 48 ( per cent) are general practitiners in private practice, 74 ( per cent) are emplyed as hspital staff, 4 (4 per cent) are paid by medical schls as full-time faculty members, 7 thers (5 per cent) are primarily in research wrk but d nt receive a majrity f their incme frm a medical schl, ( per cent) are in administrative wrk, 7 ( per cent) are in labratry medicine (67 f these are pathlgists nt in private practice), 44 ( per cent) are in preventive medicine, 75 ( per cent) are nt in practice, and 5 are retired. On the whle, this distributin f activities is similar t that f physicians in the same age range wh are graduates f U.S. schls. The prprtin f pathlgists and "hspital staff," hwever, is smewhat higher amng Latin American graduates. With regard t the varius specialties, the distributin f Latin American graduates is similar t that f physicians wh are dmestic graduates. Of the,47 Latin Americans, 574 are generalists. The mst ppular specialities are general surgery, 54; internal medicine, ; psychiatry, 9; pathlgy, 7; and pedi atrics, 6. Anesthesilgy claims -a prprtin f 5 per cent, as against per cent amng U.S. physicians. The distributin f prfessinal activities accrding t schl graduated frm and cuntry f rigin varies cnsiderably. One tenth f all Latin American graduates are engaged in fulltime academic wrk as research wrkers r medical schl faculty, but the prprtin is much higher fr graduates f the University, f Buens Aires ( per cent), the University f Córdba, Argentina ( per cent), and fr the graduates f Brazilian schls (4 per cent). (The Brazilian graduates are gruped tgether because each f 4 schls has cntributed a small number t the ver-all ttal f 98.) In cntrast, nly 6 per cent f the graduates f the Natinal University f Mexic 9

40 City are in full-time academic wrk. The prprtin nt engaged in medical wrk is 7 per cent amng Sant Dming graduates, whereas nly per cent f the graduates f ther schls are emplyed in nnmedical fields. A census in the academic year 96-6 cunted 4 Latin American students in U.S. and Canadian schls f public health. Data are nt available n hw many f these were physicians r n what their visa status was. TABLE 5. BIOMEDICAL RESEARCH TRAINEES FROM LATIN AMERICA SUPPORTED BY NIH TRAINING GRANTS TO U.S. INSTITUTIONS* Citizens f Latin American cuntries U.S. citizens Cuntry nm- Nn- Visa brn in Ttal at nimmi- status Latin Ttal grat gran t un- America visa knwn Ttal Argentina 5 7 Blivia Brazil 8 6 Chile 9 Clmbia 5 7 Cuba 7 Dminican Rep. 5 Ecuadr El Salvadr Guatemala 6 6 Guyana t Haiti Hnduras Jamaica 4 4 Mexic Nicaragua Panama 5 Paraguay Peru Trinidad and Tbag 6 Uruguay Venezuela 5 5 Surce: Direct infrmatin, Natinal Institutes f Health. * Abut 8 per cent are physicians. Abut half f the Latin American bimedical research trainees in the United States are supprted by this means. t Frmerly British Guiana Research trainees There are rughly 5 Latin American physicians in the United States engaged primarily in research training. In 964 a ttal f 6 research trainees were supprted by the Natinal Institutes f Health (NIH) thrugh grants t U.S. institutins (Table 5). Mst f these were physicians. Thrugh this type f grant alne, NIH supprted 5 research trainees frm Argentina, frm Cuba, 5 frm Mexic, 8 frm Brazil, and frm Chile, Clmbia, and Peru. Abut half f the 6 held immigrant visas, and 55 were U.S. citizens brn in Latin America. During the perid , NIH granted pstdctral fellwships fr study in the United States t 4 Latin Americans (Table 6). Nineteen such fellwships were awarded t Latin Americans in 965. In 96 a study was made f the status f 99 research trainees wh had been supprted by NIH thrugh grants t U.S. institutins between 955 and 96 (Table 7). These trainees were all brn in Latin America, and they cnstituted abut per cent f all bimedical research trainees frm Latin America during that perid. At the start f TABLE 6. NIH INTERNATIONAL POSTDOCTORAL FELLOWSHIPS TO LATIN AMERICANS, Cuntry Ttal Ttal Argentina Blivia Brazil Chile Clmbia Csta Rica El Salvadr Mexic Peru Uruguay Venezuela West Indies I Surce: Direct infrmatin, Natinal Institutes f Health. 'f

41 TABLE 7. FORMER NIH RESEARCH TRAINEES FROM LATIN AMERICA, FOLLOW-UP AND CITIZENSHIP STATUS IN 96 Cuntry f birth Returned t Still In third Lcatin N. cuntry in U.S. cuntry unknwn f birth Ttals U.S. citizens Citizens f Latin American cuntries Argentina U.S. citizen at start f training in U.S. Citizen f Argentina Blivia U.S. citizen at start f training in U.S. Citizen f Blivia Brazil U.S. citizen at start f training in U.S. Citizen f Brazil Chile U.S. citizen at start f training in U.S. Citizen f Chile Clmbia U.S. citizen at start f training in U.S. Citizen f Clmbia Csta Rica U.S. citizen at start f training in U.S. Citizen f Csta Rica Cuba U.S. citizen at start f training in U.S. Citizen f Cuba Dminican Republic U.S. citizen at start f training in U.S. Citizen f Dminican Republic Ecuadr U.S. citizen at start f training in U.S. Citizen f Ecuadr French West Indies U.S. citizen at start f training in U.S. Citizen f French West Indies Guatemala U.S. citizen at start f training in U.S. Citizen f Guatemala Jamaica U.S. citizen at start f training in U.S. Citizen f Jamaica Mexic U.S. citizen at start f training in U.S. Citizen f Mexic Peru U.S. citizen at start f training in U.S. Citizen f Peru Trinidad U.S. citizen at start f training in U.S. Citizen f Trinidad Venezuela U.S. citizen at start f training in U.S. Citizen f Venezuela Surce: Direct infrmatin, Natinal Institutes f Health (Clmbia) (Brazil) 6 (Chile) (Canada) O O O 6 5 4

42 their research training, 5 were U.S. citizens and 74 were citizens f ther cuntries. At the time f the study, f the latter grup were still in the United States, 4 had returned t their native cuntries in Latin America, and had left the United States but were nt in their native cuntries ( f the having gne t ther cuntries in Latin America). The lcatin f 7 was unknwn. Further infrmatin n the grup f wh were still in the United States suggested that as many as half f these might later return t Latin America. On the basis f these and ther data it may be cncluded that in recent years rughly 5 per cent f the Latin American medical research trainees wh are nt U.S. citizens when they begin training have been immigrating, while a majrity have been returning t their cuntries. Infrmatin available n the 45 research trainees wh had returned t Latin America shwed that 75 per cent were engaged t sme extent in teaching and 7 per cent were ding research. Thse wh were engaged in research spent an average f abut 4 per cent f their time in research and thse in teaching were devting an average f per cent f their time t teaching. Altgether, abut 65 per cent were devting a majrity f their time t academic pursuits and 85 per cent were ding sme srt f academic wrk. A 96 sample survey f research prjects supprted by NIH grants (these are different frm the training grants mentined abve) identified 7 citizens f Latin American cuntries. Since the sample included abut per cent f all bimedical research wrkers in the United States in 96, the ttal number f Latin Americans in this field may be estimated at between and 4. Prbably abut 5 f these were physicians and sme f the physicians were research trainees. The same survey als identified 9 U.S. citizens brn in Latin America. Since 96 there has been an increase in the number f research wrkers in the United States wh are natives f Latin America Scientists and teachers Indirect evidence suggests that perhaps 5 per cent f thse physicians wh are ptential scientists and teachers are being lst t Latin America thrugh migratin. As stated befre, ne tenth f the,47 Latin American graduates studied by the AMA held full-time academic psitins as research wrkers r medical schl faculty as f early 966. Others, such as full-time members f hspital staffs, als perfrmed sme academic wrk, but nly the 4 wh described themselves as primarily research wrkers r full-time faculty were included in the subsequent AMA study n scientists and teachers. Questinnaires were sent t 75 persns in this grup (Appendix VIII). Of these, 49 were cmpleted and retumed. One was excluded, since the respndent was a native f the United States. The remaining 48 replies were then subjected t analysis. The final sample thus represented 5 per cent f the entire grup f 4 full-time academic wrkers described abve. All f these academicians had graduated prir t 96. Fur had graduated in 96, between 955 and 959, between 95 and 954, 7 between 94 and 949, and prir t 94. All f thse wh were U.S. citizens had graduated befre 956. Seventeen were U.S. citizens and were citizens f ther cuntries. Only 5 f these graduated befre 954. Visa status was learned fr 8 f the wh were nt U.S. citizens: 6 had immigrant visas, 8 had permanent resident visas, and 4 had visitr visas. Of the wh were nt U.S. citizens, had licenses t practice in the state f residence, had temprary licenses, and 5 were unlicensed. The licensure status f is unknwn. In the grup f 8 U.S. citizens, had licenses and 5 did nt. In 4 instances the primary purpse f the first visit t the United States is knwn: 8 came initially as interns, as residents, as research trainees, and as a faculty member. Of the 4 U.S. citizens wh answered the.,

43 questin, indicated that they definitely planned t remain permanently in the United States, ne indicated that he definitely planned t return t his cuntry, and ne indicated that he prbably wuld return. The answers f the 7 wh were nt U.S. citizens were quite different: 5 said they definitely planned t return, 7 mre said they prbably wuld return, and 4 indicated that they might return althugh this was nt likely. Only 5 f 7 had definitely decided t stay permanently in the United States. All but ne f the 48 academicians were married: had married U.S. natives, 8 had married natives f their wn cuntry, and 9 had married natives f ther cuntries. In 6 f these 9 instances the husband had left his native cuntry (such as Paraguay) t attend medical schl elsewhere in Latin America (Argentina, fr example) and had eventually married a wman frm the latter cuntry. It appears that in sme cases the decisin t immigrate preceded marriage t a U.S. native. It seems likely that in sme f the instances marriage played a rle in the decisin t immigrate. Amng the 48 academicians perhaps r 5 indicated that marriage t a U.S. citizen was an imprtant factr in the decisin t immigrate Interns and residents As f 966 there are abut, interns and residents in the United States wh are graduates f Latin American schls. In 96 there were,6, distributed as fllws: 4 frm Cuba, 56 frm Mexic, 48 frm Argentina, 5 frm Clmbia, frm Peru, 5 frm the Dminican Republic, and 87 frm Central America (induding Panama). Since the average duratin f stay fr thse wh return t their cuntries is abut three years, it appears that abut 7 Latin American graduates nw enter the United States annually t begin internships r residencies. Righly f these are U.S. citizens, and in recent years abut have been Cubans. Thus the number f nn-cuban Latin Americans wh enter annually fr internships r residencies is apprximately 48. If the present trend cntinues, abut tw thirds f these will return t their wn cuntries and rughly ne third will stay permanently in the United States. In additin, sme f thse wh return may be expected t migrate t the United States at a later time. Abut 8 per cent f the Latin American physicians wh have migrated t the United States have been interns r residents in U.S. hspitals. Data frm a variety f surces suggest that rughly half f the Latin Americans wh have cme t the United States as interns r residents in recent years will eventually migrate if they have nt already dne s. Sme f thse wh have entered as pstgraduate trainees have planned frm the beginning t migrate, but a large majrity d nt make the decisin until later. Bigraphical data were examined n a per cent sample f the freign graduates wh received their first U.S. license in 96 (U.S. natives excluded). Of a ttal f 7 Latin Americans, were frm Cuba and 6 frm ther cuntries. All f the 6 had had either internships r residencies in the United States (4 had had internships). These 6 licensees had graduated between 94 and 96. The average number f years between graduatin and arrival in the United States was three years. The average perid between graduatin and U.S. licensure was eight years Latin Americans in U.S. medical schls Data gathered by the AMA indicate that in the academic year 96-6 there were 7 Latin American students enrlled in U.S. medical schls: 5 frm Central America, 4 frm Suth America, and 7 frm "Nrth America" (Mexic and the Caribbean?). This suggests that abut 5 r Latin Americans graduate frm U.S. medical schls annually. The visa status and the subsequent mvements f this grup are nt knwn.

44 4.4 Effects Frm a purely quantitative standpint these immigratin lsses f Latin America, while highly significant, are nt catastrphic as far as the regin as a whle is cncerned. On the ther hand, the data in Figures 8 and 9 and Appendix III shw that the rates f immigratin are uneven frm cuntry t cuntry. The lsses and ptential lsses f Haiti, the Dminican Republic, Blivia, Clmbia, and the Central American cuntries are quite substantial in relatin t the capacities f these cuntries t prduce physicians. Argentina is lsing many physicians, but this number is relatively mdest in prprtin t the rate f prductin f physicians in that cuntry. Brazil's lsses in prprtin t the ppulatin and rate f prductin f physicians are virtually insignificant. The gain realized by the United States is substantial. Even ignring the Cuban migratin, it wuld take three academic medical centers f average size t prduce the same number f physicians. As pinted ut earlier, the dllar value f this manpwer apprximately equals the cst f all U.S. medical assistance t Latin America. One f the mst imprtant questins cncerning this migratin is the extent t which ptential leadership is being lst. Even thugh the manpwer drain is quantitatively mdest, it culd have a prfund effect n the develpment f sme f the natins if the lsses included a large fractin f yung physicians with utstanding ptential. There are n precise methds r criteria fr cmparing the capacities f thse wh migrate and thse wh d nt. Mrever, generalizatins fr Latin America are subject t exceptins because the nature f the migratins vary frm cuntry t cuntry. Cnclusins n this subject shuld therefre be cautius and tentative. With these reservatins, the judgments in the fllwing paragraphs are ffered. In general, the migrants riginate frm. the 4 strnger Latin American medical schls. Mst f the recent immigrants in the United States are in clinical practice, either privately r as members f hspital staffs. The capacities and ptentialities f this grup seem t be rughly cmparable t thse f their classmates wh did nt migrate. The grup f migrants wh enter clinical practice seems t include persns with average native ability, abve-average ability, and, ccasinally, belw-average ability. A sample f immigrant practitiners frm seven schls in five Latin American cuntries were asked t indicate whether their schlmates wh had migrated t the United States were, in general, average in ability, decidely belw average, r decidedly abve average (see questin 6, Appendix VIII). All f the respndents characterized the ability f migrants in their graduating class as average. The present study has yielded n evidence that the grup f migrants and ptential migrants indudes an unusual number f utstanding graduates. On the ther hand, there is sme evidence that the grup cntains a substantial number wh are interested in academic careers, and this latter subgrup has been fund t include an impressively large number f exceptinally talented persns. The academicians in the United States wh are Latin American graduates believe that their cuntries are lsing sme f their best physicians thrugh migratin t the United States. Of the 4 wh respnded t questin 6 n the questinnaire, nly ne thught that in general immigrants were belw average cmpared t their ther classmates; 6 characterized immigrants as average and thught they were definitely abve average. Here is a rather typical cmment made in respnse t the questinnaire by a Latin American wh is nw an assistant prfessr at a U.S. medical schl: "This 'brain drain' frm Latin American cuntries is certainly very bvius with respect t persns wh are interested in basic research and academic medicine. I knw a gdly number f these individuals wh were superbly trained in many f

45 areas f medicine and returned t their native cuntries nly t find themselves beset with almst impssible difficulties." Finally, it shuld be nted that there are in the United States a large number f yung Latin American scientists, teachers, and ptential scientists and teachers wh have nt made a definite decisin cncerning their cuntry f permanent residence. There are prbably as many as highly trained physicians wh wuld return t Latin America t pursue academic careers if suitable pprtunities were available. Mst f these persns wuld nt ask fr ideal wrking cnditins r large salaries, but they wuld require a certain minimum f academic stability and pprtunity. Prbably abut 5 Latin American physicians wh are academicians r research trainees are immigrating t the United States each year. This is the mst imprtant aspect f the migratin prblem. Frtunately, it is a difficulty that can be mitigated at least t sme extent. 5

46 5. WHAT CAUSES MIGRATION? The causes f migratin apply t all peple, but they relate in a particular way and with particular frce t thse with prfessinal training. Prfessinal persns are mre "migratin prne" than is the ppulatin as a whle. They are mre susceptible than ther grups t the "pushing" and "pulling" frces that give rise t migratin. The fact alne that they are highly educated, whatever their prfessin, tends t make them less tightly bund t their hme cuntries. Many peple in the yunger generatin are cmpetent in English. They are expsed t a wide variety f freign influences in the curse f their educatin. The prfessins tend t be internatinal in character, and the sciences in particular have a strng traditin f internatinal cperatin. Finally, the pprtunity fr study r prfessinal practice in the United States is a very significant factr in the migratin f highly educated peple. 5. "Deliberate Push" frm the Native Cuntry Few cuntries have ever deliberately pushed their highly trained peple t emigrate. Occasinally, hwever, this happens, as when a change f plitical regime impels certain highly trained peple t leave the cuntry. In such cases, a persn's backgrund and training are incidental and his plitical views r affiliatins are paramunt. 5. "Unintentinal Push" frm the Native Cuntry A majr cause f migratin t the United States frm Latin America is the lw level 6 f prfessinal and ecnmic pprtunity in the hme cuntries. In this cnnectin, tw pints need emphasis. First, the pprtunities available at hme d nt have t equal thse available in the United States in rder t keep peple frm emigrating. Mst physicians, scientists, and engineers, like peple everywhere, prefer t remain at hme. This is where their families are, where their rts are. They knw their wn peple, their wn custms, their wn language, their wn fd. Peple d nt generally mve frm ne cuntry t anther slely t btain a slight ecnmic r prfessinal advantage. The difference must be significant enugh t utweigh the strng natural preference t remain at hme. Secnd, the directin f change in the hme cuntry, as well as the abslute level f develpment, plays an imprtant part in the decisin t emigrate r nt. If the plitical situatin appears t be becming mre stable, the prspects fr ecnmic grwth are gd, and career pprtunities in general are imprving, then emigratin will decrease, even thugh a large gap may still exist between cnditins in the hme cuntry and cnditins in the United States. This statement is brne ut by the ver-all migratin trends in such cuntries as Venezuela, Argentina, and Mexic. In Venezuela salaries and prfessinal pprtunities are nt as favrable as in the United States, but they are adequate t frestall all but a small amunt f migratin. In Argentina the fluctuatins in the prspects fr plitical stability and ecnmic grwth are reflected-with a lag f frm six mnths t a year-in the migratin figures. u

47 In shrt, peple can be pushed ut f their cuntries, in spite f the strng natural inclinatin t remain at hme, if cnditins are s unsatisfactry that they feel they must leave. These cnditins may be the srt that impel all types f citizens t migrate: general plitical unrest and uncertainty as t the future, plitics in the universities, lw incmes, general lack f hpe fr the future, inflatin, difficulty in getting ahead withut plitical r family influence. In sme cuntries, such as Argentina, the cst and scarcity f husing is anther imprtant factr leading t emigratin and inhibiting repatriatin. In additin, prfessinal peple may be faced with special cnditins: the part-time system and pr remuneratin in universities, difficulty in utilizing their advanced training, r prblems in maintaining cntact with the wrld cmmunity in their particular prfessin. The highly imprtant factr f incme can be illustrated by the case f physicians in Clmbia. Many physicians in the majr cities have a difficult time making a living. The abslute minimum incme required by a yung bachelr physician is abut 5, pess a mnth and by a physician with a small family abut 7, pess per mnth-the equivalent f an annual incme f between $4, and $5, in the United States. Many find it impssible t earn this much in the majr cities. An ffer f a psitin in the gvernment service at a salary f 9, pess per mnth wuld prduce an avalanche f applicants. Medical services are, f curse, urgently needed in rural areas, but a physician wh mves t the cuntryside sentences his family t cultural exile and pverty. The prfessinal salary structure in Clmbia is strngly influenced by the gvernment salary, structure, since a high prprtin f the demand fr prfessinally trained peple arises frm gvernment activities. N gvernment emplyee may be paid mre than a minister, and ministers receive a salary f 6,6 pess a mnth-the rugh equivalent f an annual incme f $6, in the United States. This, then, is the tp incme t which prfessinals in gvernment service may aspire. Many have undubtedly reflected that the same salary is cmmanded by cmpetent secretaries in the United States. The case f Clmbia is duplicated, with minr variatins, in many Latin American cuntries. The Gutiérrez and Riquelme study f migratin frm Chile has prduced the nly firm data n a pint vital t a study f migratinsalaries f high-level migrants befre and after migrating.9 The existence f wide salary differentials between Latin American cuntries and the United States is well knwn-particularly by thse wh migrate frm varius cuntries-and need nt be prved by statistics. The value f the Chilean data is that it prvides, in effect, "befre and after" case studies f individual migrants and that it makes the existence f the salary differentials particularly graphic. Salaries befre migratin were relatively lw. Almst half f the migrants reprted salaries f less than $5 a mnth befre they left Chile (Table 8). Hwever, this grup is heavily weighted with unemplyed persns and new entrants int the labr market. When such peple are excluded, 75 per cent f the remaining grup had salaries f between $5 and $ per mnth. In cntrast, nly 8 per cent f the migrants reprted a first salary in the United States f less than $ per mnth. Almst three quarters f the migrants reprted current salaries f ver $4 per mnth, and 4 per cent reprted salaries f $8 a mnth r mre. Clearly, there is n realistic prspect that salaries in Chile will match thse in the United States in the freseeable future. This is true f all ther Latin American cuntries with the pssible exceptin f Venezuela, althugh salaries in sme cuntries, such as Mexic, are higher than thse in Chile. 9 S. Gutiérrez and J. Riquelme, La Emigración de Recurss Humans de Alt Nivel y el Cas de Chile, Washingtn, D.C., Unión Panamericana,

48 The prblem is nt slely ecnmic, hwever. Irnically, cuntries may encurage the emigratin nt nly f highly trained peple but f the best f the highly trained thrugh their very effrts t raise standards f educatin in engineering, science, and medicine. Indeed, this is als true f technical training, and the lss f skilled technicians and nurses is in sme cuntries as serius a prblem as the migratin f prfessinal peple. The Faculty f Medicine at the Valle University in Cali, Clmbia, presents a specific example f the prblems generated by elevatin f levels f educatin. This faculty is excellent, and it has been the frtunate and deserving recipient f much freign assistance designed t make it an utstanding Latin American center f medical educatin. Yet lk at the distributin f its graduates frm the class f 958: Ttal Residence Number Clmbia United States Other Latin American cuntries... 5 Eurpe... Percentage Migratin and balanced natinal develpment One imprtant surce f "unintentinal push" frm the hme cuntry is unbalanced natinal develpment. The cncept f balance is just as fundamental t the evlutin f cuntries in the early phases f develpment as it is t cuntries that have reached the advanced stages. Ideally, certain factrs wuld remain in balance thrughut the curse f a natin's develpment: the rate f ecnmic grwth, the rate f general cultural develpment, the develpment f the educatinal system at all levels, the institutinal frms fr educatin at all levels, and the develpment f adequate human resurces t meet evlving needs. But such an ideal is virtually impssible t attain. Mrever, its value lies in its existence as an ideal, rather than as a gal t be TABLE 8. COMPARATIVE INCOME DISTRIBUTION OF CHILEAN MIGRANTS TO THE UNITED STATES, BEFORE AND AFTER MIGRATION, AS OF 96 Chile Last salary in Chile Mntlily Excludsalary* All ing the min- t grants under 5- Ttal Under Over Mnthly salary Under Over United States First Current salary salary in the in the U.S. U.S Surce: S. Gutiérrez and J. Riquelme, La Emigración de Recurss Humans de Alt Nivel y el Cas de Chile, Washingtn, D. C., Unión Panamericana, 965, Cuadr V, pp. -. * U.S. dllar equivalent. achieved and sustained. Prgress in the affairs f natins des nt take place in an even and balanced manner; it ccurs as spurts in varius sectrs. These spurts make fr imbalances that natins must then try t remedy. The prcess f seeking t achieve a balance is the essence f prgress. In this prcess, dislcatins are inherent; they are a means f adjusting t the unevenness f the develpment prcess. If they are nt t severe, the adjustments are prductive in the lng run. They may be regarded as just a nrmal price t be paid fr develpment itself. Migratin is an evidence f imbalance in the develpment prcess-simply ne f a variety f dislcatins that are inherent in a highly cmplex, dynamic prcess. It is virtually impssible t prduce highly trained peple at the precise rate required fr the develpment f natinal ecnmies. One primary bstacle is the persistence f bslete patterns f prfessinal educatin. It may be claimed, fr example, that because f the high status f the medical prfessin in the culture sme Latin American cuntries train an exces- r 8

49 sive number f physicians. It is felt that the resurces devted t the educatin f physicians culd be better used fr natinal develpment and fr the training f ther grups such as engineers and technicians. Anther cause fr difficulty in the develpment f human resurces is the length f the training perid. Fr instance, deliberate effrts t extend the advanced training f chemists, such as thse that have been made in Argentina, rest n the assumptin that very special types f industries will develp five t ten years hence. Nt all prjectins f future manpwer needs turn ut t be accurate. The training f academic scientists is ften based n the expectatin that career pprtunities nt existing at the time f training will be available when the training is cmpleted. These expectatins, which frequently depend n drastic changes in laws, custms, and administrative structures f universities, are nt always fulfilled. Just as human resurce shrtages can aggravate the prblem f imbalance, imbalance amng the sectrs can, in turn, have a negative effect n the training prcess. T take ne example, the training f nurses depends n the develpment f medical and related services. A similar situatin ften btains in ther public service prfessins. 5.. Plitical instability In Latin America as a whle, plitical instability is a majr factr f "unintentinal push" Y that frces highly trained peple t leave their hme cuntries. Generally, highly educated peple in Latin America are nt neutral in their beliefs. They tend t have definite plitical views, which they express in a variety f ways. Attitudes tward the structure f universities, 5. attitudes tward gvernment plicy n science, attitudes tward the acceptance f utside assistance fr research, attitudes tward scientific relatinships with the Western Blc r the Eastern Blc, as well as direct plitical affiliatins, establish the individual scientist's psitin >I n the plitical spectrum. When changes f gvernment result in a change in the prevailing plitical philsphy, thse wh are ut f sympathy with the gvernment smetimes find it impssible t remain prductively at wrk. The pressures n individuals range frm mild harrassment t physical frce. A substantial prtin f the migratin f scientists frm Latin America is traceable t plitical factrs. Plitical instability itself, regardless f an individual's views and the prevailing plitical philsphy, als tends t push peple ut f their wn cuntries. Instability means uncertainty. Uncertainty generates uneasiness, tensin, and fear f the future. These reactins are ften the decisive factr amng prfessinally trained peple wh wuld therwise remain in their wn cuntries. 5. "Unintentinal Pull" t the United States The attractin f the United States, is the strngest frce affecting migratin frm Latin America. Latin American physicians, scientists, and engineers are drawn by the high incmes and relatively gd prfessinal pprtunities they see there. The attractins exist nt by reasn f any intentinal effrt n the part f individuals r the United States Gvernment, but rather by reasn f the very nature f the culture and the ecnmy. Many plicies f the United States since Wrld War II have tended t enhance this attractin. High, stable levels f emplyment have expanded the general demand fr prfessinal as well as ther wrkers. Sharp increases in the need fr physicians have nt been matched by the annual utput f graduates. Large research and develpment expenditures have created heavy demands fr scientists and engineers. University plicies have made it pssible t establish thusands f new academic psitins at all levels. In general, the plicies that have been cnsidered apprpriate fr the internal develpment f the United States have at the same time 9

50 been plicies that wuld attract peple frm ther cuntries. Cnversely, plicies that wuld effectively discurage the mvement f talented peple t the United States have been dmestically unacceptable because they wuld lead t ecnmic stagnatin and t the restrictin f prfessinal and ecnmic pprtunities. Other internal plicies that wuld have reduced the unintentinal pull t the United States might have been, but were nt in fact, acceptable. Fr example, an intensive effrt sme time back t step up the prductin f physicians in the United States might have helped t avid the deficit that is nw affecting the reserves in ther cuntries. Tday the Latin American cuntries are helping t meet the demand fr physicians that the United States, by inactin, failed t prvide fr a decade ag. Higher rates f prductin f Ph.D.'s in the sciences wuld have had the same effect. 5.4 "Intentinal Pull" t the United States "Intentinal pull" n the part f the United States Gvernment has been nnexistent. The frmal actins f gvernment specifically related t migratin have been in the directin f restraining it; t wit, the requirement that persns with an exchange visitr's visa spend tw years utside the United States. Hwever, the United States Gvernment has nt taken strng, direct steps t discurage the migratin f highly trained persns frm Latin America thrugh such devices as the impsitin f admissin qutas n these particular grups. A number f private emplyers, including universities and industrial research labratries, in the United States have deliberately ffered psitins t Latin Americans. These ffers are frequently very attractive in terms f incme and prfessinal pprtunities-equipment, space, facilities, assistants, and prfessinal assciatins. Hwever, nt a large prprtin f highly trained migrants cme t the United States this way. The mre cmmn pattern is fr them t cme first n a visit-as students, turists, emplyees, r self-emplyed wrkers. Then, after a perid f assessment, the decisin t migrate is made. It is during r after this perid that prfessinal pprtunities are ffered in the United States. Thus, it is difficult t determine in the case f many individuals the frces that "pushed" and thse that "pulled," and the extent t which these frces were intentinal r unintentinal. 5.5 Why Physicians Migrate Althugh physicians are generally subject t the same frces that affect ther prfessinals, their situatin is smewhat different, and special attentin has been paid t this grup. The frces tending t increase r decrease migratin were evaluated frm several different angles. Many physicians thrughut Latin America wh did nt migrate were interviewed. This grup included sme wh had and sme wh had nt received pstgraduate training in the United States. In additin, a large number f immigrants and ptential immigrants in the United States were cnsulted. And finally, the 75 replies t the questinnaire described in the previus sectin were carefully studied (Appendix VIII). The reasns fr immigrating r fr nt immigrating t the United States vary frm cuntry t cuntry and within cuntries frm ne individual t anther. Althugh the decisin t leave r remain in the native cuntry is usually influenced by a variety f factrs, ften a single ne will be decisive. Fr example, marriage t a citizen f the United States may tip the scales in favr f immigratin, r the ffer f a specific jb at hme may be decisive in the repatriatin f a Latin American. In the case f physicians, the factrs that encurage and inhibit migratin can be listed in their apprximate rder f their imprtance: 4

51 Factrs encuraging migratin f physicians Factrs inhibiting migratin f physicians Lack f prfessinal Lack f fluency in English pprtunity Very lw incme Adequate lcal career Pr resurces and pprtunities facilities Adequate salary Pr (des nt prfessinal have t envirnment equal U.S. salaries) Prfessinal plitics Adequate equipment, Plitical instability, resurces, facilities limitatin f persnal Gd prfessinal r prfes- envirnment sinal freedm Advancement based Lack f immigratin n prfessinal qutas in the U.S. Prfessinal pprtunities in U.S. merit Pr quality f medical educatin Patritism, lyalty t Marriage t U.S. native lcal sciety and cuntry, pineer Liberal state licensure spirit laws in U.S. Plitical stability and Gd medical schls freedm Pstgraduate training Scial and family ties in the U.S. High quality Licensing requirements in U.S. Gd pstgraduate Lng duratin training pprtunities in Latin High salaries Training irrelevant America t medical pririties in Latin U.S. fr thse Requirement t leave America with visitr visas Fluency in English ECFMG examinatin The estimate f "imprtance" is based n hw frequently the factr applies and the degree t which it is likely t be highly influential in determining whether a physician will leave r remain in his native cuntry. Fr example, persnal plitical persecutin is nt ften the cause f migratin, but when this factr applies it may be decisive. On the ther hand, the lack f adequate career pprtunities lcally is a very frequent cause f migratin and in a majrity f cases this is a primary cnsideratin. The requirement t pass the examinatin f the Educatin Cuncil fr Freign Medical Graduates applies t mst ptential immigrants, since all wh wish t take internships r residencies in the United States must pass it. Persns wh d nt have the fluency in English r the prfessinal cmpetence t pass the examinatin usually lack the kind f qualificatins necessary t pursue careers in the United States and wuld nt wish t immigrate in the first place. Only in a sense, then, des the examinatin serve t limit the ptential number f immigrants. Althugh fluency in English, gd undergraduate medical educatin in Latin America, and pstgraduate training pprtunities in the United States all have a ptentiality fr increasing the rate f migratin, nne f these factrs in themselves causes migratin. It is instructive t cnsider which f the factrs listed are susceptible t change. Mdificatin f sme f these determinants wuld be ut f the questin, even thugh such changes wuld tend t cntrl the rate f immigratin. Fr example, maintaining a pr medical educatin system wuld reduce the number f ptential migrants, but this is bviusly undesirable. There remain a variety f factrs, hwever, that are susceptible t mdificatin. Fr example, the migratin rate wuld be reduced by imprving pstgraduate training prgrams and career pprtunities in Latin America, and by encuraging pstgraduate training in the United States nly when the training is relevant t the circumstances existing in Latin America. Three kinds f plitical factrs lead t the emigratin f physicians. One f these, nt frequent, is persnal plitical persecutin. A secnd plitical difficulty, mre general in nature, is the kind that is characterized by a lessening f prfessinal freedm and stability. Bth f these difficulties are part f the brader prblems f the Latin American peple, an evaluatin f which is beynd the scpe f this discussin. Hwever, there is a third kind f "plitical" difficulty that the medical prfessin culd have mre influence in mitigating. Many emigrants and ptential emigrants charge that prfessinal advancement in their native 4

52 cuntries is nt based n merit r accmplishment. They say they wuld be willing t live and serve in Latin America at levels f incme substantially belw what they culd earn in the United States if nly the prspects fr prfessinal advancement were mre related t prfessinal merit and less related t plitical, scial, r ecnmic influence. Almst withut exceptin, ptential migrants, including physicians, are drawn t their native cuntries by a genuine lyalty and patritism. In mst cases migratin ccurs nly when ther cntrary frces f cnsiderable imprtance utweigh the desire t wrk in their native cuntries. The majrity f ptential migrants are willing t wrk in their wn cuntries under ecnmic, scial, and prfessinal cnditins that are in many respects inferir t thse in the United States. Fr the mst part, immigratin has nly ccurred when repatriatin wuld require great persnal r prfessinal sacrifice. Althugh pstgraduate training in the United States is a majr factr in increasing the rate f immigratin, there is a great deal f evidence that such experiences are nt necessarily assciated with a high risk f emigratin. Appraisal f the prgrams f the Kellgg and Rckefeller Fundatins, the NIH Internatinal Fellwship Prgram, and the training prgrams f PAHO and AID indicates that under certain cnditins U.S. training is assciated with a very lw rate f "defectin." Usually these prgrams are designed t prvide well-planned, well-timed training experiences fr wellselected trainees; the training is specifically cnceived t fit the career prspects f the trainee; and supprt is ften cntingent n reasnable evidence that circumstances will permit the applicatin f such training. Often plans have been made t prvide sme type f further supprt during the initial phase f the returnee's career in his wn cuntry. These successful prgrams are nt characterized by rigidity f plicies, but rather by simple, sensible planning f the training experience Measuring the "Push" and "Pull" Frces Data frm Argentina can be used t illustrate an explratry means f quantifying the "push" and "pull" frces. The essential suggestin is that when there are wide fluctuatins in migratin ver a perid f time the minimum level represents the "pull" f the United States and all migratin abve the minimum represents the "push" frm the Latin American cuntry. Over the 5-year perid frm 95 thrugh 965, a ttal f,65 physicians frm Argentina were admitted as immigrants t the United States. The mvement by 5-year perids was as fllws: Ttal, Since the mre recent years are f particular interest, the annual breakdwn fr is as fllws: Variatins frm year t year are significant. Prbably mre than twice as many physicians migrated in 964 as in 96. Emigratin f t physicians in 964 and 965 was higher than in any year since 95. Accrding t the thery, these rapid and significant changes are attributable t differences in cnditins in Argentina rather than t changes in the United States. One can estimate rughly hw many ' migrants are "pushed" frm Argentina by adverse circumstances and hw many are "pulled" t the United States by relatively gd circumstances n the basis f the hypthesis that the minimum migratin figures ver the past decade represent the "pull" factr and

53 that all migratin abve the minimum represents the "push" factr. The lwest figures during the decade were 7 in 959 and 74 in 96. It may be assumed, then, that 7 migrants per year were "pulled" t the United States and that the remainder were "pushed" frm Argentina. Thus, ver the last decade a ttal f 7 migrants were "pulled" t the United States and 7 migrants were "pushed" frm Argentina. Or, in ther wrds, abut 7 per cent f the migrants were primarily attracted by the United States and per cent were primarily repelled by cnditins in Argentina. This hypthesis als prvides a useful indicatin f the vlume f migratin that may be expected t cntinue even if future cnditins in Argentina are relatively stable. It wuld appear reasnable t assume that a minimum f 7 r 8 physicians will cntinue t migrate frm Argentina under the best f circumstances. Migratin data may be used nt nly t measure "push" and "pull" frces but als t relate migratin t the changes in the "push" frces ver time. In Argentina, fr example, it appears that plitical disturbances result in an increase in persns admitted t the United States abut a year after the disturbances ccur. After Perón was verthrwn in 954 there was a perid f uneasy time under the interim gvernment. While migratin had been lw during the Perón perid, reaching a maximum f abut per year, the figure climbed t 77 in (Table 9). Similarly, when the Frndizi gvernment was in difficulty in 96 and 96 migratin rse a little bit, but by the fllwing year it had sared t,57 -abut duble the average fr After a trublesme perid, it apparently takes peple a substantial time t make the emtinal, material, and bureaucratic arrangements necessary t translate the thught f migratin int an act. If this analysis is cr- Migrants are here cnsidered equal t thse admitted with immigrant visas, althugh the number f migrants is actually smaller. The imprtant factr, hwever, is the change frm perid t perid. TABLE 9. MIGRATION OF PROFESSIONAL, TECHNICAL, AND KINDRED WORKERS FROM ARGENTINA, CORRELATED WITH DOMESTIC CONDITIONS Year Number admitted t the U.S. with immigrant visas (Perón depsed) (Interim Gvernment) (Frndizi depsed) , Surce: Figures frm U.S. Department f Justice, Immigratin and Naturalizatin Service (see Appendix II). rect, the number f Argentine prfessinal, technical, and kindred wrkers entering the United States will rise markedly abve the level in Assessment f the Frces Affecting Migratin It is clear that the unintentinal frces in Latin America and in the United States are much mre imprtant than the intentinal frces. The gvernments f the Latin American cuntries d nt intend t cmpel highly talented persns t leave, and the gvernment f the United States des nt intend t draw talented peple frm Latin America. Yet bth f them, by unintended effects f general plicies-r lack f plicies-generate frces that lead t extensive migratins. Part f the migratin f highly skilled peple frm Latin America t the United States results frm differences in ecnmic and prfessinal pprtunities that will nt disappear. Fr example, amng prfessinal migrants frm Chile, nly 5 per cent had an incme f $5 a mnth r mre befre leaving Chile, 4

54 but 75 per cent f them are earning $4 a mnth r mre in the United States. A realistic apprach t the prblem f migratin must rest n the assumptin that there will be a cntinuing flw f prfessinal peple frm Latin America t the United States. Only if the Latin American cuntries and the United States were t place unthinkable limitatins n the rights f individuals culd migratin be halted. The fact that migratin rates vary widely frm cuntry t cuntry, and frm year t year in the same cuntry, indicates that changing cnditins in the Latin American cuntries have an imprtant effect n the flw. This is a significant finding, since it leads t the cnclusin that deliberate effrts t imprve cnditins in Latin American cuntries can affect migratin. A substantial prprtin f the migratin f highly trained peple frm Latin America t the United States culd be avided by the adptin f plicies that the Latin American cuntries can affrd. The primary bstacles t the adptin and executin f effective plicies are nt ecnmic, but are rather institutinal, cultural, and plitical. One majr deterrent is the lack f understanding n the part f fficials wh are in a psitin t institute the necessary measures. Anther is the absence f a central pint f fficial respnsibility fr science and manpwer within the gvernment. Only Argentina has made rganized effrts t bring back her emigré scientists and t cnduct fficial migratin studies. Perhaps the mst significant measures have been thse designed t enhance the status f scientists in Argentina thrugh the effrts f the Natinal Cuncil fr Scientific and Technical Research (CNICT). The establishment f the career investigatr plan has undubtedly cntributed t the return f sme scientists. In additin t these general measures, specific inducements Gutiérrez and Riquelme, p. cit., p.. Decree 7558 f 965 (see Appendix IX). 44 have been ffered. Fr example, upn mving back t Argentina, scientists wh had migrated t ther cuntries have been accrded taxexempt privileges n the imprtatin f scientific instruments and apparatus, an autmbile, and persnal effects up t a value f $4,. The nrmal tax had been s heavy that it was keeping away sme scientists wh might therwise have returned. Careful attentin has been paid t the appintment f returning scientists t suitable chairs and t the prvisin f adequate research space, equipment, assistance, and funds fr their wrk. The Frd Fundatin made a grant f $4, in 96 t the Natinal Cuncil fr Scientific and Technical Investigatin t be used t encurage the return f eminent Argentine scientists wrking in ther cuntries. These measures all cncentrate n the repatriatin f eminent academic scientists. It is generally believed that they are the emigré grup mst imprtant t the natinal welfare. Mrever, the grup is relatively small, its members will readily identify, and special inducements are likely t be effective with these peple. N rganized effrt has been made t persuade physicians, engineers, and thers engaged in the nnacademic phases f their prfessins t return. Of 474 persns wh might take advantage f the special inducements t return ffered by Argentina, 88 have actually gne back. With the aid f a Frd Fundatin grant, the Natinal Cuncil has kept a recrd f 8 particularly eminent scientists wh returned in They were all highly qualified, and each ne represented an imprtant additin t Argentina's university faculties. Of the 8 wh returned, 4 had been in varius labratries (including different universities) in the United States, had been in France, and in Denmark. Ten f the 8 are in the bi- Decree 754 f 964 (see Appendix X). 4 Data kindly supplied by Mr. Raúl G. B. Hinsch, Executive Secretary f the Natinal Cuncil fr Scientific and Technical Investigatin.

55 medical sciences. With the exceptin f ne wh returned t full-time research in an independent institute, all f them tk psitins in universities. In view f the heavy cncentratin f research in Buens Aires, it is ntewrthy that half f thse wh returned went t prvincial universities-la Plata (), Cuy (), Córdba (), Sur (), Tucumán (), and Crrientes (). Argentina's investment f time and effrt t secure the return f scientists has been well rewarded. Perhaps similar plans culd be adpted by ther cuntries. It shuld be kept in mind, hwever, that such measures cannt in themselves eliminate the fundamental causes fr migratin-witness the plitical events that tk place in Argentina in July and August 966. The degree f awareness f the prblem f migratin in varius cuntries has depended mre n the initiative f a few individuals than n the seriusness f the prblem. Fr example, excellent and adequately publicized studies in Chile and Argentina have directed a great deal f public attentin t the migratin questin (see Bibligraphy). In cntrast, the mre serius migratin frm Clmbia has been virtually unnticed in that cuntry. 45

56 6. WHAT SHOULD BE DONE? 6. The Intractable Basics and the Feasible Migratin f highly trained peple frm Latin America t the United States is basically the result f factrs that wuld nt be affected by recmmendatins in a reprt such as this-lw levels f incme, inflatin, plitical instability, verwhelming numbers f prly qualified university students, lack f pprtunities t pursue and develp prfessinal skills, archaic university systems, frustrating bureaucratic delays, and plitical influence ver prfessinal appintments and prmtins. Changes in fundamental cnditins such as these cme abut slwly; they are the cnsequence f the prcess f develpment itself. In the United States as well there are many basic factrs giving rise t migratin that are nt amenable t change thrugh recmmendatins. The dynamism f the ecnmy, which generates insatiable demands fr persns with highly develped skills and prfessinal training, the rapid grwth f research in universities, and the extreme shrtage f physicians-these all result frm frces s fundamental that recmmendatins will d little if anything t mdify them. Since the factrs that affect change are s numerus, perhaps expressins f views frm infrmed surces and the presentatin f new, significant, and little-knwn facts can tuch n at least sme aspects f the cnstellatin. This reprt, therefre, takes nte f many basic causes f migratin that are nt amenable t quick change. Apart frm fundamental ecnmic, scial, and plitical cnsideratins, there are imprtant cntributry factrs that can be mdified by specific actins within the ecnmic capacity f every natin. This reprt cncentrates n such actins. Even if they were adpted in ttal, hwever, they wuld nt stp all migratin. Indeed, the ablitin f migratin is impracticable and undesirable. Mvement f peple frm ne natin t anther is generally helpful t individuals and t cuntries. The purpse f these recmmendatins is t prevent the nrmal frm becming pathlgical, abnrmal, and harmful. 6. Physicians, Scientists, and Engineers Differentiated The measures that are required t retain prfessinal peple such as engineers and practicing physicians are, by and large, the basic ecnmic, plitical, and scial changes required fr natinal develpment. There are a few measures that can be specifically designed t reduce the migratin f these grups. Even if such measures culd be devised, there are s many engineers and physicians that the cst 4 wuld be excessive. The case f scientists, hwever, is a special ne. In abslute numbers, few f them migrate, but the lss per scientist is very high t the cuntries cncerned. The mvement f ne scientist can, and has, meant the ruin f an entire university department and the disbandment f a whle field f research. The scientists wh wrk in their wn cuntries are teachers and leaders as well as investigatrs. Hence, the gain in keeping scientists at hme, r repatriating them, is very 46

57 high per scientist. The ttal number f scientists in any cuntry is small in relatin t the number f practicing engineers and physicians. Accrdingly, the ttal investment required t mderate the mvement f scientists is relatively small and the return is extrardinarily high. 6. The Respnsibilities f Individuals While recmmendatins t individuals are nt particularly apprpriate, bservatins n the respnsibilities f individuals are relevant. This matter has been presented directly and persuasively by Prfessr Hussay: Science des nt have a hmeland, but the scientist des-the land where he was brn and educated; the land that nurtured him, gave him his schling, and gave him a place in his prfessin; the hme f his friends and family... Every man has a tacit, unsigned cmmitment t help his cuntry. His educatin has been made pssible by the labrs f the entire ppulatinfarmers, industrial wrkers, and prfessinal peple-wh prduced the resurces that maintained him and supprted the schls and universities. He shuld repay the peple by devting his highest effrts t the advancement f his cuntry. 5 The PAHO Advisry Cmmittee n Medical Research fully endrses this philsphy. 6.4 Recmmendatins t the Latin American Cuntries The primary respnsibility fr taking steps t mderate the mvement f highly trained peple t the United States rests with the Latin American cuntries. The differentials in terms f prfessinal pprtunity, incme, and stability that give rise t migratin shuld be 5 B. Hussay, La Emigración de Científics, Prfesinales y Técnics de la Argentina (presented at a sympsium cnducted by the Brazilian Academy f Sciences, Ri de Janeir, May 966), p.. reduced by raising rather than by lwering prfessinal and ecnmic pprtunities. The nature f the measures relating t migratin that are apprpriate and feasible differ widely amng the Latin American cuntries. Hwever, the recmmendatins in the present reprt are stated as if Latin America were a single unit. This is dne with full knwledge f the extent f diversity, but with the central assumptin that the prpsals will stimulate leaders t select, chse, adapt, delete, and add measures suited t the specific needs and capabilities f their cuntries General meastures t strengthen science in Latin America The actins required t reduce the migratin f scientists frm Latin America are precisely thse required t establish strnger science and technlgy. The fllwing steps tward the strengthening f science have been unifrmly recmmended by natinal and internatinal study grups: * An increase in the ver-all level f investment in science and science educatin The need fr expanded and stable supprt fr science and science educatin is urgent. In mst cuntries such supprt is nly pssible thrugh external assistance. Hwever, the strengthening f indigenus science and educatin is the cnstant bjective, and in this the natins have a respnsibility that they have nt yet adequately met. A reasnable gal fr investment in research might be set at between.5 and. per cent f the grss natinal prduct, depending n the relative wealth f the natin. Research is an investment, nt an expenditure. Carefully planned investments in research and higher educatin are amng the mst prfitable that a cuntry can make, and mst Latin American cuntries d nt invest enugh in these fields. Mre imprtant than the pririty f any given scientific field r the chice f emphasis between science and technlgy is the size f the ttal investment in research develpment 47

58 and technlgy. The mst fundamental prblem cnfrnting the develpment f scienceincluding bimedical science-in Latin America relates nt t any specific deficiency but t a cmplex f scial attitudes that result in a nnscientific r an antiscientific attitude n the part f the ppulatin generally and ften n the part f plitical leaders as well. The science leaders in Latin America bear a heavy respnsibility t change these attitudes. Mre intensive and effective applied research and develpment is a prime gal, but its pursuit shuld nt detract frm effrts in basic research. * Strengthening f existing centers High pririty shuld be given t the reinfrcement f existing strength in engineering, science, and medicine. In general, investments in selected existing centers f high qualityrganizatins already in being that have gd leadership, facilities, equipment, and studentswill yield a greater return in terms f the training and quality f research than investments in new centers. In general, and as a lng-range bjective, emphasis shuld be n strengthening the areas f excellence-departments, faculties, research grups, institutes, r whatever they may bethat have a strng educatinal cmpnent. This, as a rule, means areas assciated with universities. Sme universities are s archaic, badly rganized, and prly staffed, hwever, that they fall far shrt f the ideal institutin cmbining teaching and research. In such cases it is necessary t cnsider the strengthening f nnuniversity pints f excellence. N specific recmmendatins are ffered fr the slutin f the deeply rted prblems typical f mst Latin American universities. Certainly thse wh are wrking tward the needed refrms deserve every encuragement. Assistance shuld be directed as much as pssible tward strengthening the psitin f thse wh are trying t mdernize the utlk and structure f universities. * Establishment f links amng dmestic and internatinal centers f strength-an internatinal cmmn market Existing effrts t link the pints f strength within each cuntry and frm strnger ttal natinal systems are cmmendable and shuld be encuraged. Such effrts are being made in Argentina, Brazil, Chile, Clmbia, and Venezuela. A strnger natinal system enables peple t be trained t higher levels within their wn cuntries. The higher the level f training at hme, the less the prbability f migratin. Internatinal links are imprtant, t. N natin can wisely pursue a plicy f autarchy in science. The smaller the cuntry, the greater the difficulty in establishing a slid structure fr science and the greater the need fr strng links t wrld science. A degree f islatin can be useful t scientists as a prtectin against unprductive cnfrmity, but this is nly desirable under special circumstances. The need fr cmmunicatin-fr mre widespread effrts t establish free and easy cllabratin within cuntries, fr an increased flw f scientific infrmatin and peple amng natins, and fr a strnger netwrk f internatinal activities-is particularly acute in Latin America. Accrdingly, it is prpsed t extend the "cmmn market" idea t the creatin f an internatinal intellectual cmmunity, r cmmn market, building n the excellent steps already taken. Specifically, active leadership, staff assistance, and funds shuld be prvided by internatinal rganizatins fr the develpment f advanced training-t the Ph.D. level in sme casestaking advantage f existing centers f excellence wherever they may be fund in Latin America. The full explitatin and expansin f Latin America's capability t ffer advanced scientific training is a majr means f preventing undesirable migratin. Precedents fr such actin exist-fr example, the prgram f the Latin American Physilgical Sciety, which has selected centers after screening a much larger number n the basis f bjective criteria. 48

59 The Pan American Federatin f Assciatins f Medical Schls is a ptential instrument fr develping such arrangements. Mre fellwships shuld be made available fr study by Latin Americans in ther Latin American cuntries. Steps in this directin have been taken by the Frd and Guggenheim Fundatins and by the Organizatin f American States. AID is financing the study f a substantial number f Latin American students in Mexic. Frm the standpint f the Latin American cuntries, expansin f this s-called "third cuntry" training wuld be highly desirable, even if financed by reducing the number f fellwships fr study in the United States. * Imprvement in the rganizatin f scienceestablishment f strng natinal research bdies The absence f a means by which all factrs affecting research can be cnsidered in their relatin t each ther is a majr handicap in mst cuntries, and the need fr natinal bdies cmpetent t deal with such prblems is critical. Indeed, the entire cmplex f factrs-training, emigratin f highly trained persns, research supprt, university structure, full-time jbs, and all the thers that vitally affect a cuntry's capacity t cnduct a vigrus research effrt-must be cnsidered tgether. Characteristically, research in Latin America lacks rganizatin and cherence. True, there are dangers in verrganizatin; hwever, the Latin American case is ne f ineffective rganizatin. The fragmentatin f the university, the lack f cherence in science at the natinal level, and the weakness f internatinal cllabratin-all are evidence, at different levels, f inadequate rganizatin. Every Latin American cuntry with multiple centers f research-and every cuntry with emerging pints f scientific strength-shuld have an fficial natinal agency devted t science plicy. The establishment f such a bdy shuld nt be cnsidered desirable simply because it is the fashin t set up this kind f rganizatin. There are real and imprtant tasks t be perfrmed fr science. The first f these is the making f decisins regarding the natinal investment in science as cntrasted with ther fields. This is essentially a plitical matter and generally and quite prperly lies in the hands f the plitical authrities. Often the authrities have little cmprehensin f the pwer f science and technlgy in relatin t ecnmic and cultural develpment. A natinal science bdy can be a vital link between the plitical authrities and the scientific and technlgical cmmunities. The secnd task is scientific, and relates t the prblem f chice. Every natin has a science plicy cnsisting f de fact decisins. The real questin is hw these decisins are made-are they develped in a cntext that reveals the pssible cnsequences f chices befre they are made, permits an examinatin f alternative chices, and expses the general relatinships between the use f resurces fr research and higher educatin and their investment in ther imprtant gals such as secndary educatin, public wrks, r defense? If such chices are t be made with a reasnably high degree f ratinality, and if gvernments are t be guided tward intelligent chices, deliberate attentin must be paid t these matters at the natinal level. The natinal research bdy can play a key rle in this prcess. Natinal research bdies can als cllect and analyze data n resurces fr science and technlgy, imprve cmmunicatin amng scientists in ther cuntries, and serve as a link with internatinal bdies and surces f scientific cllabratin and supprt in ther cuntries. Finally, natinal research bdies are the natural instrument fr viewing the questin f migratin f highly trained peple in the ttal cntext f natinal affairs and fr securing effective actin. * Organized planning f study abrad Study abrad cntinues t be an essential part f the educatin f many highly trained persns in Latin America. Much f this training is btained in the United States. Hwever, 49

60 well-knwn and cntinuing deficiencies in the planning f training pprtunities detract frm the usefulness f such prgrams. Inadequate planning tends t increase migratin. As nted abve, training pprtunities shuld be expanded within Latin America t help minimize reliance n training elsewhere. Training in Latin America tends t be mre clsely related t dmestic needs and capabilities, it is much less expensive, and it tends t decrease bth the incentives and the pprtunities t migrate. Thse wh d study abrad shuld first exhaust all training pprtunities f adequate quality in Latin America. The lder the students are when they g abrad fr study, the mre likely they are t be married and therefre t return t the hme cuntry. The nature f training abrad shuld be related t needs and pprtunities at hme. Whenever pssible, psitins relevant t the advanced training shuld be assured befre individuals g abrad fr training. In many cuntries it is imprtant t cnsider, befre peple are trained, hw many specialists the cuntry can absrb in the particular field. This is ne aspect f general manpwer planning. In specific terms related t migratin, serius questins have been raised as t the advisibility f prviding mre fellwships befre the issue f jbs and careers is reslved. These recmmendatins are nt new. They are reiterated here because they are imprtant and because deficiencies in the training prcess cntinue t exist. Many individuals g abrad fr advanced training n their wn initiative and nt under fficial auspices. They have a right t d s, but thse wh advise them have a respnsibility t help them decide n the nature f their freign training Specific repatriatin measuresprmtin f migratin studies Each cuntry shuld stimulate, perhaps thrugh subsidizing the necessary research, studies f the extent, nature, and causes f the migratin f highly trained peple. The investigatins spnsred by the Natinal Academy f Science f Brazil, the studies f health manpwer carried ut in Clmbia, the schlarly investigatins cnducted by the Trcuat di Tella Institute in Argentina, and the special study f Chilean emigratin recently cmpleted by Gutiérrez and Riquelme are examples f the varius practical appraches that cuntries can take. Any such study must have, as a prime requirement, the interest and supprt f an influential persn and the services f at least ne cmpetent schlar t carry it ut. Gvernments, research cuncils, prfessinal scieties, and similar grups have a respnsibility t prmte such research, t publicize the results, and t cnsider the implicatins fr psitive actin. * Cnduct f fficial inquiries Natinal gvernments shuld institute fficial inquiries int the migratin questin, cnducted by apprpriate persns r grups. The investigatins shuld be aimed at discvering the nature and extent f migratin and making realistic recmmendatins. The investigatin undertaken in Argentina (Decree 7558 f 965) culd serve as a mdel (see Appendix IX). * Imprvement f migratin statistics The biggest deficiency in migratin statistics is the scarcity f data n the number and characteristics f persns wh retumrn t their hme cuntries after varius perids abrad. Clearly, the usefulness f extensive infrmatin n persns entering the United States with immigrant visas is substantially reduced by the fact that little is knwn abut the number wh return. Only in the case f physicians are there any reliable data at all. Anther serius statistical gap exists with respect t the migratin f freigners t Latin American cuntries. Argentina is the nly cuntry in which this subject has been studied (see Bibligraphy). The Organizatin f American States shuld 5

61 add t its statistical prgram a technical review f migratin statistics with the aim f strengthening the data available. * Adptin f a repatriatin prgram Each cuntry shuld give full cnsideratin t a prgram fr repatriating prfessinally trained persnnel. This prgram shuld be the respnsibility f a persn highly placed in an influential rganizatin either in r cnnected with the gvernment. The measures that shuld be cnsidered include () rganized effrts, thrugh gvernment and prfessinal scieties, t keep track f all highly trained peple wh migrate, and rganized effrts t secure names and addresses f highly trained natinals residing in the United States; and () the prvisin f special inducements fr thse willing t return. The primary and mst pwerful inducements are general rather than specific-namely, favrable plitical, ecnmic, and scial cnditins with adequate pprtunities fr prfessinal wrk. Hwever, special inducements might be ffered in the frm f guaranteed husing accmmdatins at reasnable prices, tax-exempt privileges n the imprtatin f husehld gds and an autmbile, assured supprt fr research, and assured career pprtunities. Specifically which inducements might be ffered t the different prfessinal grups wuld vary frm cuntry t cuntry. In general, it wuld appear mst feasible and prductive t ffer special inducements t persns wh wuld be assciated n a full-time basis with institutins engaged in research and advanced training. This grup is relatively small and has special imprtance t natinal develpment. 6.5 Recmmendatins t the United States Since the primary respnsibility fr mderating migratin rests with Latin American cuntries, the recmmendatins t the United States are relatively brief. Sme arrangements already in existence are helping t mderate the flw. Fr example, persns with exchange visitr and student visas are required t remain utside the United States fr at least tw years befre they can secure an immigrant visa. This cnstitutes a wise, mderate, and helpful curb n the migratin f highly trained peple frm Latin America t the United States. Anther curb is the existing system f examinatin fr freign physicians administered by the Educatinal Cuncil fr Freign Medical Graduates (ECFMG), which perates t the advantage f the Latin American cuntries, t the United States, t physicians, and t patients. The examinatin is merely evidence that thse wh pass it pssess a medical educatin equal t the minimum expected f physicians in the United States. The ECFMG examinatin shuld be designed t select physicians frm Latin America with at least average as cmpared t minimum qualificatins. This wuld tend t lwer the number f migrating physicians. It wuld als increase the average qualificatins f thse wh migrate and affrd them better status and psitins in the United States. The training f abut 9, Latin American citizens per year in the United States is an imprtant factr in the ttal educatin scheme f Latin American cuntries and it ffers significant advantages t the United States. Hwever, greater care shuld be exercised t keep this training prgram frm becming the first stage f migratin t the United States. * Cnsideratin f special assistance fr the develpment f Latin American universities The mst effective cntributin the United States culd make tward mderating the immigratin f academic persns-scientists, engineers, physicians, and thers-wuld be t establish a general plan f assistance t Latin American universities. This plan shuld have as its bjective the strengthening f universities t meet natinal requirements fr cultural, scientific, and ecnmic develpment. The assistance shuld nt be directed tward 5

62 specific prjects; rather, it shuld be aimed tward the develpment f high cmpetence in brad areas f teaching and research. The United States shuld devte further effrts t encuraging prfessrs frm U.S. universities t cnduct research and t teach pstgraduate curses in Latin American universities, remaining lng enugh t exert a strng influence ver grups f students and thereby ramify and perpetuate the effect f their wrk. T the extent that the United States cnsiders the develpment f strng, stable universities in Latin America t be in its wn interest, serius cnsideratin shuld be given t assisting suitable prfessrs frm Eurpe r ther areas t teach and cnduct research in Latin America. It is difficult t persuade prfessrs frm ther areas t teach and carry n research in Latin America. As a practical matter, strnger incentives shuld be made available in terms f incme, career prtectin, and ther factrs. Strnger effrts shuld be made t place mre pstgraduate fellws frm the United States in Latin American universities fr substantial perids. * Maintenance f research supprt t Latin America Certain agencies f the United States gvernment supprt research in Latin America t attain specific, limited bjectives within the framewrk f their wn stated gals. Hwever, as an unintended but highly imprtant cnsequence, this supprt helps t sustain the vitality f many f the mst imprtant Latin American research institutins. Thus the supprt f scientific research is ne f the mst imprtant actins taken by the United States t frestall the migratin f scientists and t prmte their repatriatin. Withdrawal f this supprt wuld, in turn, have as an unintended but certain cnsequence the cllapse f many labratries and the migratin f a substantial prtin f the scientific talent f Latin America t the United States. 5 T the extent that United States plicy favrs the strengthening f science and the academic structure generally in Latin America, the trend f research supprt shuld be viewed in a wider cntext than the specific, limited bjectives f the separate agencies that are engaged in such prgrams. * Crdinatin f existing research supprt The United States shuld accept the principle that its actins with respect t research supprt in Latin America bear directly n brader aspects f plicy. The nature and extent f U.S. supprt fr research in Latin America determines the level f effectiveness f mst majr research centers, including their capacity t train advanced students. Since the strengthening f higher educatin in the sciences and the mderatin f migratin rates frm Latin America are f basic cncern t the United States, sme means f using research supprt mre effectively t achieve these wider bjectives wuld be valuable. It wuld be helpful if the ttal effects f all U.S. research supprt in a given cuntry culd be cnsidered, insfar as pssible, in relatin t the ver-all natinal develpment. * Encuragement f "third cuntry" training As lng as the United States Gvernment is dispsed t invest funds in the training f Latin Americans fr wrk in their wn cuntries, a marked increase in supprt fr training in lcal institutins shuld be cnsidered. Such an increase wuld be particularly welcme if it invlved n decrease in training pprtunities in the United States. Clearly, assistance t training prgrams within Latin America has a higher pririty, frm the standpint f the Latin American cuntries, than increased pprtunities fr study in the United States. * Cnsideratin f ethical respnsibilities in recruitment Research leaders under whm yunger Latin American scientists wrk, learn, and teach in the United States have an ethical respnsibility y

63 t recruit in a manner that will ensure the return f as many as pssible t their hme cuntries. Individuals and rganizatins wh seek emplyees r prfessinal assciates in Latin America shuld give serius cnsideratin t the cntributin that these peple are making t their cmmunities and t their natins. The United States has a respnsibility t help Latin American students btain better cunseling befre they cme t the United States. In this cnnectin, the effrts that have been made by Educatin and Wrld Affairs, a private fundatin, are cmmendable. The aim f this rganizatin is t prmte the establishment f cunseling, evaluatin, and testing centers fr prspective student visitrs t the United States. 6 Gd advice t prspective students is s fundamental t effective training and educatin that this activity shuld be financed by bth private and public funds. * Imprvement f migratin statistics The data available frm the U.S. Immigratin and Naturalizatin Service are the mst significant single surce f infrmatin n migratin frm Latin America t the United States. Hwever, these statistics culd be imprved t gd advantage. First, it wuld be helpful if data n the individual ccupatins in the prfessinal, technical, and kindred wrker grup were tabulated every year and made available in printed frm. Secnd, it wuld be helpful if the ccupatinal classificatin f persns were made mre reliable. Hw t d this is a technical matter nt within the prvince f this reprt. Perhaps a jint U.S.-Latin American cnference f experts culd wrk ut a practical apprach t the slutin f this prblem. 6Educatin and Wrld Affairs, The Overseas Selectin f Freign Students, New Yrk, Recmmendatins t Internatinal Organizatins 6.6. United Natins The manpwer aspects f natinal develpment, including the migratin f highly trained persns, shuld be mre strngly emphasized by the Cmmittee n Science and Technlgy f the Ecnmic and Scial Cuncil. UNESCO shuld spnsr studies n the mvement f highly skilled persns frm less t mre develped cuntries, cncentrating n areas where migratin studies have nt previusly been made Organizatin f American States The manpwer studies f the OAS shuld be expanded t include current studies n migratin. The Organizatin shuld als establish lng-range basic statistical series in this area Wrld Health Organizatin and Pan American Health Organizatin The Wrld Health Organizatin shuld analyze the internatinal migratin f physicians n a wrldwide basis, determine the implicatins f this migratin, and advcate apprpriate actin. The Pan American Health Organizatin shuld use the present reprt, supplemented by additinal data and infrmed pinins, as the basis fr an apprpriate plicy statement regarding the migratin f health persnnel t, frm, and amng the Latin American cuntries. This reprt and the PAHO plicy statement shuld be widely distributed in all the cuntries f the Western Hemisphere. The Pan American Health Organizatin shuld extend its ttal fellwship prgram, and in s ding it shuld place greater stress n the training f bimedical scientists. 5

64 i

65 BIBLIOGRAPHY ALARCóN, D. G. Evaluación de la Necesidad de Médics de la República Mexicana y Planeación de la Enseñanza Médica. Méxic, D.F., Universidad Autónma de Méxic, Facultad de Medicina, 965. CANAL-FEIJóO, B. Ls éxds selects. Revista de la Universidad de Buens Aires, 96,, CiAPuscI, H. P. O. Emigración e inmigración de técnics. Revista de la Dirección Nacinal de Migracines (Buens Aires), 965,. COUCEIRO, A. M. O Papel d Cnselh Nacinal de Pesquisas na Educa á d Cientista. Prepared fr the meeting f the Brazilian Sciety fr Scientific Prgress, Bel Hriznte, July, 965. DEDIJER, S. Why did Daedalus leave? Science, June, 96, :47, Migratin f scientists: A wrld-wide phenmenn and prblem. Nature, March 7, 966, :49, DE LATTES, Z. Cnsecuencias Demgráficas de ls Mvimients Migratris Internacinales en la República Argentina, Prepared fr the United Natins Wrld Ppulatin Cnference, Belgrade, 965. EDUCATION AND WORLD AFFAIRS. The Overseas Selectin f Freign Students. New Yrk, 966. FREEMAN, C., and YOUNG, A. The Research and Develpment Effrts in Western Eurpe, Nrth America, and the Sviet Unin. Paris, Organisatin fr Ecnmic C-peratin and Develpment, 965. GIAMBIAGI, J. J., and thers. Exd de científics y técnics. Revista de la Universidad de Buens Aires, 96,, 8-9. GIORGI, L. La Pérdida de Persnal Científic y de Ingeniers en América Latina pr Migración hacia Países Más Adelantads: Magnitud, Carácter y Causas. Prepared fr the Cnference n the Applicatin f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September -, 965 (UNESCO/CASTALA/..9). GRUBEL, H. B., and SCOTT, A. D. The internatinal flw f human capital. American Ecnmic Review, May 966, 56:, GUTIÉRREZ, S., and RIQUELME, J. La Emigración de Recurss Humans de Alt Nivel y el Cas de Chile. Washingtn, D.C., Unión Panamericana, 965. HANIOTIS, G. V. An exercise in vluntary repatriatin in Greece. OECD Observer, August 964,, -5. HRwITZ, M. A. La Emigración de Prfesinales y Técnics Argentins. Buens Aires, Institut Trcuat di Tella, 96. HUSsAY, B. La Emigración de Científics, Prfesinales y Técnics de la Argentina. Prepared fr the Sympsium arranged by the Brazilian Academy f Sciences, Ri de Janeir, May, 966. INSTITUTO COLOMBIANO DE ESPECIALIZACIÓN TÉCNICA EN EL EXTERIOR (ICETEX). Resurces and Requirements fr Highly Trained Persnnel. Bgtá, 966. INSTITUTE OF INTERNATIONAL EDUCATION. Open Drs, 965: Reprt n Internatinal Exchange. New Yrk, The Institute, 965. JOHNSON, H. G. The ecnmics f the brain-drain: The Canadian case. Minerva, 965, :, 99-. KIDD, C. V. The lss f scientists frm less t mre develped cuntries. In U.S. Agency fr Internatinal Develpment, United States Papers Prepared fr the United Natins Cnference n the Applicatin f Science and Technlgy fr the Less Develped Areas, vl. 9. Washingtn, D.C., 96, 8-6. The grwth f science and the distributin f scientists amng natins. Impact, 964, 4: The ecnmics f the 'brain-drain.' Minerva, 965, 4:, 5-6. KIRK, D. Majr migratins since Wrld War II. In Milbank Memrial Fund, Selected Studies f Migratin since Wrld War II. New Yrk, the Fund, 958. MORAVCSIK, M. J. Technical assistance and fundamental research in underdevelped cuntries. Minerva, 964, :,

66 MYERS, C. A. Educatin and natinal develpment in Mexic. In Harbisn, F. H., and Myers, A. A. (eds.), Manpwer and Educatin: Cuntry Studies in Ecnmic Develpment. New Yrk, McGraw-Hill, 965. NATIONAL SCIENCE FOUNDATION. Scientists and engineers frm abrad, fiscal years 96 and 96. Reviews f Data n Science Resurces (Washingtn), July 965, :5, -8. Natinwide crisis in nursing; survey pints up the pressing need fr mre well-trained RN's. Medical Wrld News, January 8, 966, 7:. OTEIZA, E. La emigración de ingeniers de la Argentina: Un cas de 'brain drain' latinamerican. Revista Internacinal del Trabaj, December 965, 7:6, La Emigración de Ingeniers dentr del Cntext de las Migracines Internacinales en la Argentina: Un Cas de 'Brain Drain' Latinamerican. Prepared fr the Cnference n the Applicatin f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September -, 965 (UNESCO/CASTALA/..9 Add.).. Infrme sbre la Emigración de Prfesinales Técnics y Obrers Calificads Argentins a ls Estads Unids. Buens Aires, Institut Trcuat di Tella, 965. PAN AMERICAN SANITARY BUREAU. Health Cnditins in the Americas, Prepared fr the XV Meeting f the Directing Cuncil, Washingtn, 964 (Scientific Publicatin N. 4). PAN AMERICAN UNION, DEPARTMENT OF SCIENTIFIC AFFAIRS. Ls Estudis de Recurss Humans en el Cntext de la Planificación y la Metdlgía en América Latina. Prepared fr the Cnference n the Applicatin f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September -, 965. PERKINS, J. A. Freign aid and the brain drain. Freign Affairs, July 966, 44:4, ROYAL SOCIETY. The Emigratin f Scientists frm the United Kingdm: Reprt f a Cmmittee Appinted by the Ryal Sciety. Lndn, 96. UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION, DEPART- MENT OF THE APPLICATION OF SCIENCE TO DEVELOPMENT. Persnal Dcente, Niveles, Grad de Especialización, y Cndicines de Ingres en Estudis de Ingeniería. Prepared fr the Cnference n the Applicatin f Science and Technlgy t the Develpment f Latin America, Santiag, Chile, September -, 965 (UNESCO/ CASTALA/..4). VENEZUELA. Bases para la Creación de un Cnsej Nacinal de Investigacines Científicas y Tecnlógicas en Venezuela: Infrme que Presenta la Cmisión Preparatria al Efect. Caracas, Juni 964. WEST, K. M. Training fr medical research: The wrld rle f the United States. Jurnal f Medical Educatin, March 964, 9:, Freign interns and residents in the United States. Jurnal f Medical Educatin, December 965, 4:, -9. What happens t Jamaica's trained nurses? The Jamaican Nurse, December 964. WOLFLE, D. Aid t the United States. Science, March, 96, 9:557, 8. ZALDUENDO, E., and thers. Oferta de Man de Obra Especializada (Universitaria y Técnica) en la República Argentina. Buens Aires, Institut Trcuat di Tella,

67 APPENDICES

68 Y~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

69 Appendix I MIGRATION OF TRAINED PEOPLE FROM LATIN AMERICA Statement f Gals and Prcedures fr a Study t be Undertaken Jintly by the Pan American Health Organizatin and the Organizatin f American States A. The Prblem July, 965 In a number f cuntries, many scientists have becme s discuraged by the bstades facing them in building a career in science and teaching that they have migrated. They are in effect pushed ut f their native cuntry. On the ther hand, they are pulled twards cuntries where career prspects in bth ecnmic and intellectual terms are much brighter. The cuntry with the mst attractin in recent years has been the United States. While the facts abut the migratin f physicians, scientists, and engineers are nt knwn with precisin, it is abundantly clear that in sme cuntries the lss f talent is a severe handicap t natinal ecnmic, cultural, and intellectual develpment. Much mre attentin has been paid t the utflw f capital than t the utflw f anther fundamental natinal resurce-brains. This prblem is nt, f curse, cnfined t the bimedical sciences. Hwever, as is true f s many aspects f sciences in Latin America, the bimedical sciences are s significant that they can best be examined in the cntext f all sciences. Whether the frces that repel r thse that attract are mst pwerful is nt the central prblem. The central prblem is hw bth frces may be mderated in a suitable way. There can be n realistic hpe that the frces leading t the emigratin f scientists frm Latin America can be dne away with and that migratin will cease. The frces at wrk are t deeply ingrained and t pwerful. Mrever, the cessatin f migratin is nt nly impssible but unwise. Internatinal migratin f scientists is a prductive phenmenn with which the wrld has lng been familiar. The bject f plicy shuld be t establish cnditins under which the rate f migratin frm Latin America will be mderated by the vluntary chice f individuals. Frtunately, it appears that there are practical measures, which can be instituted at mderate cst, that will reduce migratin. B. General Prpsal fr Actin by PAHO It is mst urgent that the prblem be mre specifically diagnsed and that a practical prescriptin be written. The Pan American Health Organizatin and the Organizatin f American States are therefre instituting a study, in cperatin with all grups having an interest in the questin. The study will begin with a determinatin f relevant facts. Next, the frces leading t migratin shuld be analyzed. The analysis shuld result in suggestins fr practical, acceptable measures designed t recncile the legitimate aspiratins f scientists with the legitimate needs f the cuntries fr highly trained manpwer. C. Infrmatin t Be Secured While it is nt pssible t knw precisely what infrmatin will be secured, the categries f facts and judgments that will be sught can be utlined. They fall int three brad categries. 59

70 Part A. Statistical Data n Migrants frm and t Latin America. Number and characteristics f migrants frm Latin America a. Number f physicians, number f scientists, and number f engineers wh have migrated frm each Latin American cuntry in each year ver the past ten years; cuntry t which they have migrated; specialties (within each f the three majr ccupatinal grups) f thse wh have migrated. b. Number f nurses, technicians, and thse in ther imprtant subprfessinal grups wh have migrated; cuntry t which they have migrated. (The U.S. is the mst significant cuntry, and mst f the data will be n migrants t the U.S. New and mre refined data will be sught frm the U.S. Immigratin and Naturalizatin Service.). Number and characteristics f migrants t Latin American cuntries Venezuela will be particularly imprtant in this cnnectin, althugh data will be sught n this subject frm all cuntries.. Number and characteristics f persns wh have returned t Latin America after migrating. Few peple will be in this categry and it will prbably be impssible t secure a statistical cunt. Persns in this categry are very imprtant t the study because their experience can prvide leads t the kinds f plicies required t bring peple back. Part B. Reasns fr Migratin frm Latin America An effrt will be made t assess reasns fr migratin by questining migrants in the United States. Prcedures fr this may include a questinnaire. Preferably, infrmatin will be sught by persnal interviews cnducted by Latin Americans. The basic questins are these: * Is the cause primarily the attractin f ther cuntries? Is the attractin primarily ecnmic, r are ther factrs invlved? * Is the cause primarily cnditins within the cuntry? What is the relative significance f ecnmic and plitical factrs? * What is the significance f persnal factrs, such as temperament r family circumstances? Part C. Judgments and Plicies Finally, judgments will be sught, primarily thrugh interviews with a varied sample f infrmed peple in varius Latin American cuntries, n questins such as the fllwing:. Hw serius is the prblem f migratin f scientists, f engineers, and f physicians? * Why is the prblem serius, if it is? * If the prblem is nt serius, what accunts fr the fact that few peple migrate? * Why the differences amng different ccupatinal grups?. What specific measures have been taken, if any, t reduce the migratin f scientists, engineers, physicians, and subprfessinal grups? 6

71 * Hw have such measures differed, if at all, frm thse intended t create a mre favrable climate fr science r the practice f medicine r engineering in the natin?. Hw significant is the mvement f peple t each cuntry (in-migratin) in meeting requirements fr highly trained manpwer? 4. What specific measures have been taken, if any, t induce thse wh have migrated t return? Hw successful have they been? What accunts fr their effectiveness r lack f effectiveness? D. Planning, Directin, and Advice The study will be planned and directed by Dr. Charles V. Kidd, wh will be respnsible fr drafting a reprt. PAHO and the Department f Scientific Affairs f the OAS General Secretariat will prvide staff advice and assistance within the limits f their available resurces. The reprt will be reviewed by the PAHO Advisry Cmmittee n Medical Research as a whle at its meeting in June 966, but the PAHO/ACMR will nt assume respnsibility fr the cntent f the reprt. Similarly, the Department f Scientific Affairs may arrange fr a review f the draft study. The study will prceed under the general guidance f a PAHO/ACMR Subcmmittee n Migratin, cnsisting f all f the Latin American members f the Cmmittee, under the chairmanship f Dr. Bernard A. Hussay. Similarly, the Department f Scientific Affairs may establish an advisry grup. The Subcmmittee will review draft material by mail and will prbably meet nce early in 966 t discuss the prgress f the study, t review data and draft manuscript material, and t advise n final steps. Lgistical supprt fr the study will be prvided by PAHO headquarters and its zne ffices. The Department f Scientific Affairs will assist by prviding access t data and infrmed peple. E. Study Prcedures. Review f literature All pertinent literature and existing data n migratin f scientists, particularly frm Latin America, will be examined.. Cntact with apprpriate grups The study will be discussed with apprpriate individuals and grups interested in the migratin f scientists (including the Directrate fr Scientific Affairs f the Organisatin fr Ecnmic C-peratin and Develpment, the Natinal Science Fundatin, and UNESCO) t explain the scpe, bjectives and prcedures fr the study, and t discuss the pssibilities f cllabrative effrt.. Establishment f definitins It will be necessary t establish wrking definitins fr terms such as "migrants," "students n fellwships," "visiting prfessrs," "persns with immigrant visas," and s frth. Anther required definitin relates t the qualificatins f thse t be cnsidered in the study. Fr example, hw is a "scientist" t be defined? t be included? As a preliminary judgment bth aspects shuld be part f the study. 6

72 4. Cllectin f U.S. data Arrangements will be made fr cllectin f statistical data frm the U.S. Bureau f the Census, the Immigratin and Naturalizatin Service, and the Natinal Science FPundatin n scientific migrants t the U.S. frm Latin America ver the last decade, by cuntry and by ccupatinal grup. Analysis will be made f the data. 5. Cllectin f Latin American data Arrangements will be made fr cllectin f such data as may be available frm the Latin American cuntries, requesting members f the PAHO Advisry Cmmittee n Medical Research and persns suggested by the Department f Scientific Affairs t prvide access t peple and data. 6. Cnduct f sample survey T determine the relative imprtance f varius frces affecting their migratin, a sample study f Latin American scientists wh have migrated t the U.S. will be planned and executed. 7. Interviews in Latin America After arranging in advance fr apprpriate interviews, the views f infrmed peple in selected Latin American cuntries n the questin f migratin will be discussed. Heavy reliance will be placed n the assistance f members f the PAHO Advisry Cmmittee n Medical Research and persns suggested by the Department f Scientific Affairs bth t prvide infrmatin and judgment and t advise n supplemental surces f infrmatin. Eight cuntries will be discussed accrding t the fllwing schedule: September Brazil, Chile, Argentina, Peru, Uruguay December Mexic, Venezuela, Clmbia The Study Directr will visit mst f these cuntries, but assistance may be required bth in studying the situatin in these cuntries and in studying additinal cuntries if this seems desirable. Staff members f PAHO and the Department f Scientific Affairs will be asked t visit sme f the cuntries invlved. Fr thse cuntries in which discussins are nt held, data will be slicited by letter frm infrmed peple. 8. Preparatin f draf t reprt The reprt will be cmparable in length t the reprt Science Plicy in Latin America (Scientific Publicatin N. 9). It will cntain bth data and analyses f the data. Stress will be placed n plicy matters-recmmendatins as t what the Latin American cuntries and the U.S. shuld d t deal with the prblem. Supplementary reprts n a cuntry-by-cuntry basis will prbably be prepared as in the case f the reprt n bimedical research plicy because the situatin varies. The cntent f supplementary reprts will be determined during the curse f the study. 9. Timing 965 July August September Octber Nvember December Name Cmmittee Select Study Directr 6

73 965 (cnt.) July August September Octber Nvember December 966 Review literature Cntact apprpriate grups (OAS, NSF, OECD, UNESCO) Establish definitins Cllect U.S. data Cllect Latin American data Cnduct sample survey Interviews in Latin America January February March April May June July Analyze data. First rugh draft. Cmmittee meeting in Ri de Janeir. Interviews in Latin America Draft final reprt Distribute draft fr cmment Redraft Present reprt t PAHO/ACMR 6

74 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96: Cuntry r regin Ttal 8 f last residence, -e NORTH AMERICA 9, *Puert Ric (U.S.) 56 Vigin Is. (U.S.) 574 Canada 5, B *Mexic *United States West Indies, Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 6 5 Martinique (Fr.) 7 5 Bahamas (U.K.) Barbads 4 54 Jamaica Trinidad & Tbag 8 58 Antigua 9 59 Dminica 5 5 Grenada 8 5 Mntserrat 5 St. Christpher 5 St. Lucia 5 54 St. Vincent 7 55 British Virgin Is Cayman Islands 57 Turks-Caics Is. 584 *Cuba, *Dminican Republic *Hanii 7 4 Central America *Canal Zne (U.S.) 575 *Csta Rica *El Salvadr *Guatemala *Hnduras *Nicaragua 8 58 *Panama British Hnduras 9 SOUTH AMERICA, Surinam (Neth.) 6 6 Guyanat *Argentina *Blivia *Brazil *Chile *Clmbia 'Ecuadr Paraguay 694 'Per 'Uruguay 696 'Venezuela * Nnquta cuntries t Frmerly British Guiana Surce: Direct infrmatin, U.S. Department f Justice, Immigratin and Naturalizatin Service. Nte: These data have been published earlier nly in part. The full tables are presented here s that thse interested in migratin may derive infrmatin directly frm them. 64

75 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): Prfessrs and instructrs O Cuntry r regin ) z f last residence.- = NORTH AMERICA Z Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 'Canada 'Mexic 58 *United States I West Indies 4 57 Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica I I 56 Trinidad & Tbag 58 Antigua 59 Dminica 5 Grncada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba I 585 'Dminican Republic 586 'Haiti Central Amarica 54 'Canal Zne (U.S.) 575 'Csta Rica 576 El Salvadr 577 'Guatemala 578 *Hnduras 579 *Nicaragua 58 'Panama 58 British Hnduras SOUTH AMERICA 6 Surinam (Neth.) 6 Guyavat 687 *Argentina 688 'Blivia 689 *Brazil 69 Chile 69 'Clmbia 69 *Ecuadr 69 'Paraguay 694 'Peru 695 'Uruguay 696 Venezuela * Nnquta cuntries t Frmerly British Guiana 65

76 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): Prfessrs and insructrs Cuntry r regin _ f last residence z a NORTH AMERICA 'Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 'Canada *Mexic 'United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserratr 5 St. Christpher 5 St. Lucia 54 Sr. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic 'Haiti 4 Central America 'Canal Zne (U.S.) 575 'Csta Rica El Salvadr 577 *Guatemala 578 'Hnduras 579 *Nicaragua 58 'Panama 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina *Blivia 689 *Brazil 'Chile 69 'Clmbia 'Ecuadr *Paraguay 694 *Peru *Uruguay 696 *Venezuela 6 * Nnquta cuntries t Frmerly British Guiana 66

77 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): e Cuntry rregin regine 8 e e b e f last residence j e ~ '. e x <E ve ~O l t ~ en NORTH AMERICA *Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 *Canada *Mexic *United States West Indies Guadelupe (Fr.) Neth. Antilles Bcrmuda (U.K.) Martinique (Fr.) Bahamas (U.K.) Barbads Jamaica Trinidad & Tbag Antigua Dminica Grenada Mntserrat St. Christpher St. Lucia St. Vincent British Virgin Is. Cayman Islands Turks-Caics Is. *Cuba *Dminican Republic *Haiti Central America *Canal Zne (U.S.) 575 *Csta Rica 576 *El Salvadr 577 *Guatemala 578 *Hnduras *Nicaragua 7 58 *Panama 58 British Hnduras SOUTH AMERICA Surinam (Ncth.) 6 Guyanat 687 *Argentina *Blivia *Brazil *Chile 5 69 *Clmbia *Ecuadr 6 69 *Paraguay 694 *Peru *Uruguay 696 *Venezuela 5 5 * Nnquta cuntries t Frmerly British Guiana 67

78 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): Cuntry r regin f last residence ~ " * ga R. ' NORTH AMERICA ,6 55 *Putr Ric (U. S.) 56 Virgin Is. (U.S.) 574 'Canada ,6 58 *Mceic 'United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 7 5 Martinique (Fr.) 5 Bahamas (U.K.) 4 5 Barbads 54 Jamaica Trinidad & Tbag 9 58 Antigua 9 59 Dminica 5 Gtenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent I 55 British Virgia Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic *Haiti 5 5 Central America 7 6 I *Canal Zne (U.S.) 575 'Csta Rica El Salvadr 577 -Guatemala *Hnduras *Nicaragua 58 *Panama 4 58 British Hnduras SOUTH AMERICA I 4 6 Surinam (Neth.) 6 Guyanat 'Argentina 'Blivia 'Brazil 9 69 'Chile 69 -Clmbia 'Ecuadr 'Paraguay 694 'Peru *ruguay 696 *Venezuela 8 5 * Nnquta cuntries t Frmerly British Guiana 68

79 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): L. 8t, i í.6 i 5. d, _~~~~~~~~~~~~~~~~~~~~~. II_ 56 Virsin Is. (US.) 574 Canada *Merc United Stares West Indies Guadelupe (Fr.) Neth. Antilles Bermuda (U.K.) Martinique (Fr.) Bahamas (U.K.) Barbads Jamaica Trinidad & Tbag Antigua Dminica Grenada Mntserrat St. Christpher St. Lucia St. Vincent British Virgin Is. Cayman Islands Turks-Caics Is. *Cuba 'Dminican Republic *Haiti Central America *Canal Zne (U.S.) 575 *Csta Rica El Salsadr Guatemala 578 *Hnduras *Nicaragua *Panama 5 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina *Blivia Brazuil Chile 'Clmbia *Ecuadr 69 *Paraguay 694 *Peru *Uruguay 696 *Venezuela 6 5 * Nnquta cuntries t Frmerly British Guiana 69

80 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION A. Year ended June, 96 (Cnt.): Technicians Cuntry (U rregin S ). '.e --e,~ e f last residence s NORTH AMERICA , 'Puert Ric (U.S.) 56 'Virgin Is. (U.S.) 574 'Canada *Mexic 'United States 8 West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 8 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads Jamaica Trinidad & Tbag Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic 'Haiti 6 Central America 'Canal Zne (U.S.) 575 'Csta Rica 'El Salvadr 'Guatemala 'Hnduras 'Nicaragua 58 'Panama British Hnduras 4 SOUTH AMERICA Surinam (Neth.) Guyanat 'Argentina *Blivia *Brazil 'Chile 'Clmbia 'Ecuadr *Paraguay *Peru 'Uruguay *Venezuela I * Nnquta cuntries t Frmerly British Guiana ~'~FI9 A~~lrBC~ZN G f~;~lo!-s.-in P79 PAW 4blHgn*,,~, f~p~;~b

81 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96: ~ Cuntry r regin Tt. d O ' - f last residence T tale = NORTH AMERICA, 'Puert Ric (U.S.) 5 56 Virgin Is. (U.S.) 574 Canada 5, *Mexic *Unitcd States West Indies, Gnadelupe (Fr.) 58 Neth. Antilles Bermuda (U.K.) 5 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 5 Barbads Jamaica Trinidad & Tbag Antigua 9 59 Dminica 5 5 Grenada 7 5 Mntserrat 5 St. Christpher 5 5 St. Lucia 7 54 St. Vincent 5 55 British Virgin Is Cayman Islands 57 Turks-Caics Is. 584 'Cuba *Dminican Republic *Haiti 88 Central America 'Canal Zne (U.S.) 'Csta Rica 'E Salvadr 'Guatemala *Hnduras 579 *Nicaragua 'Panama 66 8 I British Hnduras SOUTH AMERICA, Surinam (Neth.) 6 Guyanat *Argentina *Blivia 'Brazil 'Chile 5 69 *Clmbia 'Ecuadr 9 69 'Paraguay *Peru 'Urnguay 9 I I 696 *Venezuela * Nnquta cuntries t Frmerly British Guiana 7

82 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Prfcssrs and instructrs Cuntry r regin f last residence 9 Z f * NORTH AMERICA 'Puert Ric (U.S.) 56 'Virgin Is. (U.S.) 574 'Canada 'Mexic 4 58 'Unitcd States West Indis 4 57 Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica 56 Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba I 585 *Dminican Republic 586 'Haiti Central America 54 *Canal Zne (U.S.) 575 'Csta Rica 576 'El Salvadr 577 'Guatemala 578 'Hnduras 579 'Nicaragua 58 *Panama 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 Argentina I 688 'Blivia 689 'Brazil 69 'Chile 69 'Clmbia 69 'Ecuadr 69 *Paraguay 694 'Peru 695 'Uruguay 696 'Venezuela Nnquta cuntries tfrmerly British Guiana 7

83 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Prfessrs and instruntrs Cuntry r regin f last residence c: `- ~ d'. W u -tu 5 I z 9 I _I_-~ la la la ~ la a l a l a l NORTH AMERICA Puert Ric (U.S.) 56 'Virgin Is. (U.S.) 574 *Canada 'Meic 'United States 6 West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic *Haiti 4 Central America 'Canal Zne (U.S.) 575 -Csta Rica 'El Salvadr 577 'Guatemala 578 *Hnduras 579 Nicaraguna 58 'Panama British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina *Blivia 'Brazil Chile Clmbia Ecuadr 'Paraguay 694 'Peru *Uruguay 696 *Vcnecucel 4 7 * Nnquta cuntries t Frmerly British Guiana ti. 7

84 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Cuntry r regin i 't E, f last residence a a E 5> m a e q i u :z 9 e 8 P.,u NORTH AMERICA 'Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 *Canada *Mexic *United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Frt.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica I Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba *Dminican Republic 586 *Haiti Central America *Canal Zne (U.S.) 575 *Csta Rica *EI Salvadr I 577 *Guatemala *Hnduras *Nicaragua 58 *Panama 6 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina *Blivia 689 *Brazil *Chile 6 I 69 *Clmbia *Ecuadr 6 69 *Paraguay 694 *Peru *Uruguay I 696 *Venezuela Nnquta cuntries t Frmerly British Guiana 74

85 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Cuntry r regin f last residence.= i <4 ' e S ti < l _l = e i 5.=.4 E n. O NORTH AMERICA _ 9 9 9, 'Puert Ric (U.S.) 'Virgin Is. (U.S.) *Canada *Mexic 'United States I 5, West Indies Guadelupe (Fr.) Neth. Antilles Bermuda (U.K.) Martinique (Fr.) Bahamas (U.K.) Barbads Jamaica Trinidad & Tbag Antigua Dminica Grenada Mntserrat St. Christpher St. Lucia St. Vincent British Virgin Is. Cayman Islands Turks-Caics Is. 'Cuba 'Dminican Republic 'Haiti Central America 'Canal Zne (U.S.) 'Csta Rica 'El Salvadr 'Guatemala 'Hnduras 'Nicaragua 'Panama British Hnduras SOUTH AMERICA Surinaum (Neth.) 6 Guyanat 687 'Argentila 688 'Blivia 'Brazil lchile *Clnibia 'Ecuadr 'Paraguay 'Pera 695 *Uruguay 696 'Venezuela 4 * Nnquta cuntries t Frmerly British Guiana 75

86 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Cuntry r regin f last residence 8,pJ : i.. i 6 u L. an g-. 9 u l.e & C L C S.5 a W,. 9 -i ea. 6e l 8 a = w.5p. nl *: r..t 5 r NORTH AMERICA Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 'Canada 'Mexic I 58 'United States 65 6 West Indies Guadelupe (Pr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag I 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic *Haiti 8 4 Central America 'Canal Zne CU.S.) 575 Csta Rica 'El Salvadr 'Guatemala 578 *Hnduras 'Nicaragua 4 58 Panama British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 'Argentina 'Blivia 'Brazil 'Chile 'Clmbia 'Ecuadr *Paraguay 'Peru 'Uruguay I 'Venezuela * Nnquta cuntries t Frmerly British Guiana 76

87 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION B. Year ended June, 96 (Cnt.): Technicians Cuntry r regin g a f last residence 8 j. '.g T-8c A9 w t i NORTH AMERICA 'Puert Ric (U.S.) 56 Virgin Is. (U.S.) 574 Canada 'Meic United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 5 54 Jamaica Trinidad & Tbag Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 4 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba *Dminican Republic 'Haiti 44 4 Central America Canal Zne (U.S.) 'Csta Rica *El Salvadr Guatemala *Hnduras 'Nicaragua 9 58 *Panama 4 58 'British Hnduras 4 SOUTH AMERICA Surinam (Neth.) 6 Gnyanat *Argentina 'Blivia 'Brazil OChile 'Clmbia *Ecuadr *Paraguay *Peru Uruguay 'Venezuela * Nnquta cuntries t Frmerly British Guiana 77

88 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96: Cuntry r regin f last residence Ttal 8 e t <, <,~ < < c u u u U 4 5 NORTH AMERICA, Puert Ric (U.S.) 8 56 *Virgin Is. (U.S.) *Canada 6, *Mexic *United States West Indies, I -- -l-i Guadelupe (Ft.) Neth. Antilles Bermuda (U.K.) Martinique (Fr.) Bahamas (U.K.) Barbads Jamaica Trinidad & Tbag Antigua Dminica Grenada Mntserrat St. Christpher St. Lucia St. Vincent British Virgin Is. Cayman Islands Turks-Caics Is. *Cuba *Dminican Republic *Haiti Central America f *Canal Zne (U.S.) *Csta Rica *El Salvadr *Guatemala *Hnduras *Nicaragua *Panama Bricish Hnduras SOU TH AMERICA, i ~~ Surinam (Neth.) 9 6 Guyanat *Argentina *Blivia 689 *Brazil *Chile *Clmbia *Ecuadr *Paraguay *Peru *Uruguay *Venezuela * Nnquta cuntries t Frmerly British Guiana

89 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.): Prfessrs and instructrs L Cuntry r regin f last residence S a s NORTH AMERICA Puert Ric (U.S.) 56 'Virgin Is. (U.S.) 574 *Canada nmexic 58 *United States Wcst Indies 4 57 Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica 56 Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 ICuba 585 *Dminican Republic 586 *Haiti Central America 54 'Canal Zne (U.S.) 575 'Csta Rica I 576 *El Salvadr 577 *Guatemala 578 *Hnduras 579 *Nicaragua 58 *Panama 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina 688 *Blivia 689 *Brail 69 'Chile 69 'Clmbia 69 'Ecuadr 69 *Paraguay 694 *Peru 695 *Uruguay 696 *Venezuela 4 * Nnquta cuntries t Frmerly British Guiana 79

90 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.): Prfessrs and instructrs O NORTH AMERICA *Puerr Ric (U.S.) I 56 Virgin Is. (U.S.) 574 *Canada *Mexic 'United Statcs West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 5 Martinque (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminican Republic 'Haiti Central America Canal Zne (U.S.) 575 'Csta Rica 'El Salvadr 577 'Guatemala *Hnduras 'Nicaragua 58 *Panama 4 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat I 687 'Argenina *Blivia 'Brazil 'Chile 'Clmbia 'Ecuadr 'Paraguay 694 Pecru 'Uruguay 696 'Venezuela * Nnquta cuntries t Frmerly British Guiana 8

91 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.): Cuntry r regin 8 U f last residence. u u.,a NORTH AMERICA Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 *Canada *Melic *United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Beramuda (UK.) I 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba *Dminican Republic *Haiti 7 5 Central Amaica *Canal Zne (U.S.) 575 'Csta Rica *El Salvadr 577 *Guatemala 578 *Hndueas 579 *Nicaragua 58 *Panama I 58 British Hnduras SOUTH AMERICA Suriam (Neth.) 6 Guyanat 687 Argentina *Blivia *Brazil Chile Clmbia *Ecuadr Paraguay 694 Peru *Uruguay *Venezuela * Nnquta cuntries t Frmerly British Guiana 8

92 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.): P., -a O. Cuntry r regin 8.. a f last residence * NORTH AMERICA , 'Puert Ric (U.S.) 56 'Virgin Is. (U.S.) 574 'Canada , 'Mexic *United States 6 7 West Indies Guadelupe (Fr.) 58 Neth. Antilles 9 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 6 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 5 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 585 'Dminican Republic *Haiti I 9 Central America 'Canal Zne (U.S.) 575 'Csta Rica 576 'El Salvadr 'Guatemala 'Hnduras 'Nicaragua 8 58 'Panama 4 58 British Hnduras 4 SOUTH AMERICA Surinam (Neth.) 6 Guyanat 'Argentina 'Blivia *Brazil 9 69 'Chile 7 69 'Clmbia 'Ecuadr 4 69 'Paraguay 694 Peru 'Uruguay 696 'Vcnczula Nnquta cuntries t Frmerly British Guiana 8

93 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.):.L. f last residence E aa 9 i t e O NORTH AMERICA Puert Ric (U.S.) I 56 'Virgi Is. (U.S.) 574 'Canada *Mexic 'United States 48 4 West Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamnas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christphr 5 St. Lacia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 'Cuba 'Dminicaa Republic 'Haiti 7 Central America 'Canal Zne (U.S.) 575 'Csta Rica 'El Salvadr 577 'Guatemala 4 I 578 'Hnduras 'Nicaragua 6 58 'Panama 58 Briish Hnduras SOJUTH AMERICA Surinam (Neth.) 6 Guyanat 'Argentina 'Blivia 'Braail 'Chile 'Clmbia 'Ecuadr 'Paraguay Ptru 'Uruguay 696 'Veneznela 5 7 * Nnquta cuntries t Frmerly British Guiana 8

94 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION C. Year ended June, 96 (Cnt.): Technicians Cuntry r regin f last residence u i.! a ~8 j ' NORTH AMERICA , *Puert Ric (UOS.) 9 56 'Virgin Is. (U.S.) 574 'Canada 'Mexic *United States West Indies Guadelupe (Frt.) 58 Neth. Antilles 59 Bermuda (U.K.) 8 5 Martinique (Fr.) 5 Bahamas (U.K) 4 5 Barbads 7 I 54 Jamaica Trinidad & Tbag Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Luda 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 Cuba *Dminican Republic 'Haiti 64 6 Central America 'Canal Zne (U.S.) *Csta Rica 'El Salvadr *Guatemala *Hnduras 'Nicaragua *Panama *British Hnduras 6 SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina 'Blivia *Brazil 'Chile 'Clmbia 'Ecuadr *Paraguay *Peru *Uruguay 'Venezuela * Nnquta cuntries t Frmerly British Guiana 84

95 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964: Cuntry r regin - f last residence Ttal C 4 5. NORTH AMERICA, *Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 *Canada 6, *Mexic *United States West Indies, Guadelupe (Fr.) 58 Neth. Antilles 5 59 Bermuda (U.K.) 4 5 Martinique (Fr.) 5 5 Bahamas (U.K.) 4 5 Barbads 7 54 Jamaica Trinidad & Tbag Antigua 59 Dminica 5 5 Grenada 5 Mntserrat 5 St. Christpher 7 5 St. Lucia 4 54 St. Vincent 4 55 British Virgin Is Cayman Islands 57 Turks-Caics Is. 584 *Cuba, *Dminican Republic *Haiti Central America *Canal Zne (U.S.) f75 *Csta Rica 6 I 576 El Salvadr *Guatemala *Hnduras *Nicaragua *Panama British Hnderas SOUTH AMERICA, Surinam (Neth.) 7 6 Guyanat *Argentina, *Blivia *Brazil *Chile *Clmbia *Ecuadr *Paraguay *Peru *Uruguay *Venezuela * Nnquta cuntries tfrmerly British Guiana 85

96 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.): Prfessrs and instructrs e %. u. Cuntry r regin - f last residence. u t NORTH AMERICA Puert Ric (U.S.) 56 Virgin Is. (U.S.) 574 'Canada *Mexic *United States 4 West Indies 5 57 Guadelupe (F.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica 56 Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba *Dminican Republic 586 *Haiti Central America 54 'Canal Zne (U.S.) 575 *Csta Rica 576 E Salvadr 577 Guatemala 578 *Hnduras 579 *Nicaagu a 58 *Panama 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 *Argentina 688 'Blivia 689 nbrazil 69 'Chile 69 'Clmbia 69 *Ecuadr 69 *Paraguay 694 *Peru 695 Urugunay 696 'Venezuela * Nnquta cuntries t Frmerly British Guiana 86

97 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.): Prfessrs and imstructrs Cuntry r regin e u. f last residence -. :y.. e -:-. u 'u NORTH AMERICA *Puert Ric (U.S.) 56 *Virgin Is. (U.S.) 574 *Canada *Mexic *United Statres Wcst Indies Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica 8 56 Trinidad & Tbag 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba 'Dminican Republic *Haiti Central America *Canal Zne (U.S.) 575 *Csta Rica *EI Salvadr 577 *Guatemala 578 *Hnduras 579 *Nicaragua 58 *Panama 58 British Hnduras SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 Argentina *Blivia *Brazil *Chile *Clmbia *Ecuadr 69 *Paraguay 694 *Peru *Urguay *Venezuela * Nnquta cuntries t Frmerly British Guiana 87

98 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.): Cuntry r regin i i : i f last residence 8 & «n Xu un.n NORTH AMERICA Puert Ric (U.S.) 56 'Virgin s. (U.S.) 574 Canada Meñic UnitedStates 5 8 I West Indies Gunadelupe (Fr.) 58 Neth. Antilles I I 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamnaica Trinidad & Tbag I 4 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lcia 54 St. Vincent 55 British Virgin Ls. 56 Cayman Islands 57 Turks-Caics i. 584 'Cuba *Dminican Republic *Haiti 5 8 Central America 5 8 I 4 54 Canal Zne (US.) 575 Csta Rica Ei Salvzdr I 577 'Guatemnala 578 Hndurs I I Nicariagua 58 Panama I 58 British Hnduras SOUTH AMERICA Srinam (Neth.) 6 Guyanat 687 'Argcntina Blivia Branil 'Chilk 4 4 I 7 69 'Clmbia 5 4 I 6 69 'Ecuadr I 69 'Paraguay 694 'Peu *Uruguay I 696 nvenezutla Nnquta cuntries t Frmerly British Guiana 88

99 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.): Cuntry r regin f last residence e r: I t *. z :i O., Ps.cf 9.M Z u w.u.u 9.u 5,.r p r.h.l «E -6. B 4 g. z f S,4 u, uo ~ I. u 8 (S I I I I II NORTH AMERICA , s 'Puert Ric (U.S.) 'Virgin Is. (U.S.) *Canada *Mexic 'United States , West Indies _ I 9 _ Guadelupe (Fr.) Neth. Antillcs Bermuda (U.K.) Martinique (Fr.) Bahamas (U.K.) Barbads Jamaica Trinidad & Tbag Antigua Dminica Grenada Mntserrat St. Christpher St. Lucia St. Vincent British Virgin Is. Cayman Islands Turks-Caics Is. *Cuba *Dminican Republic *Haiti I Central America Canal Zne (U.S.) 575 -Csta Rica El Salvadr *Guatemala 578 *Hnduras 'Nicaragua 9 58 'Panama British Hnduras 8 SOUTH AMERICA Surinam (Neth.) 6 Guyanat 687 'Argentina *Blivia *Brazil *Chile 4 69 *Clmbia *Ecuadr Paraguay 694 'Peru *Uruguay 696 *Venezuela 4 * Nnquta cuntries t Frmerly British Guiana 89

100 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.) Cuntry r regin pe a :A last tí -f resi-dence u P. a C. p e 9 9E e E _ * NORTH AMERICA *Puert Ric (US.) 56 *Virgin Is. (U.S.) 574 *Canada *Mexic *United States West Indies I I-*L--I -. *I Guadelupe (Fr.) 58 Neth. Antilles 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 54 Jamaica Trinidad & Tbag 5 58 Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 *Cuba *Dminican Republic *Haiti 8 7 Central America *Canal Zne (U.S.) 575 *Csta Rica *El Salvadr *Guatemala *Hnduras *Nicaragua 58 *Panama 4 58 Briti s h Hnduras 4 SOUTH AMERICA Surinam (Neth.) 6 Guyanat *Argentina *Blivia *Brazil *Chile *Clmbia *Ecuadr 4 69 Paraguay *Peru *Uruguay 696 *Venezuela 7 4 * Nnquta cuntries t Frmerly British Guiana 9

101 APPENDIX II: IMMIGRANTS ADMITTED TO THE UNITED STATES IN THE PROFESSIONAL, TECHNICAL, AND KINDRED WORKER GROUP, BY COUNTRY OR REGION AND BY OCCUPATION D. Year ended June, 964 (Cnt.): Technicians Cuntry r (US) regin f last residence. ' 6 *; I *~ * NORTH AMERICA , Puert Ric U.S.) 56 *Virgin Is. (U.S.) 74 Canada *Mexic United States West Indies Guadelupe (Fr.) 58 Neth. Antilles 4 59 Bermuda (U.K.) 5 Martinique (Fr.) 5 Bahamas (U.K.) 5 Barbads 6 54 Jamaica Trinidad & Tbag Antigua 59 Dminica 5 Grenada 5 Mntserrat 5 St. Christpher 5 St. Lucia 54 St. Vincent 55 British Virgin Is. 56 Cayman Islands 57 Turks-Caics Is. 584 Cuba *Dminican Republic *Haiti Central America 'Canal Zne (U.S.) 575 Csta Rica 'El Salvadr Guatemala *Hnduras *Nicaagua *Panama *British Hnduras 7 SOUTH AMERICA Surinam (Neth.) 6 Guyanat 'Argentina 'Blivia 'Brazil 'Chile 'Clmbia 'Ecuadr 'Paraguay *Peru *Uruguay 696 *Venezuela * Nnquta cuntries t Frmerly British Guiana 9

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107 Appendix IV LATIN AMERICAN MEDICAL GRADUATES IN THE UNITED STATES, BY SCHOOL AND COUNTRY OF ORIGIN* Cuntry and schl Number Ttal fr Latin America 77 Argentina 99 Buens Aires University 86 Córdba University 65 La Plata University Rsari University Tucumán University 4 Blivia 4 San Andrés University, La Paz San Francisc Xavier University, Sucre 4 San Simón University, Cchabamba 8 Brazil Schl f Medicine, Surgery and Pharmacy, Bahia 6 University f Pórt Alegre, Ri Grande d Sul University f Brazil, Ri de Janeir Sa Paul University Pará Schl f Medicine and Surgery University f Minas Gerais, Bel Hriznte 7 Recife University, Recife, Pernambuc 7 Paraná University, Curitiba 6 Faculty f Medical Sciences, Ri de Janeir 4 Ceará University, Frtaleza, Ceará Ribeira Pret Schl f Medicine 5 Paulista Schl f Medicine, Sa Paul 5 Fulminense Schl f Medicine, Niterói, Ri de Janeir Three ther Brazilian schls 5 Chile 48 University f Chile, Santiag 48 Clmbia Natinal University, Bgtá Cartagena University, Cartagena 6 Antiquia University, Medellín Cathlic University, Bgtá 9 Faculty f Medicine, Cali 9 Caldas University, Manizales Cauca University, Ppayán Cuba Havana University t t Dminican Republic 94 Sant Dming University 94 * Des nt include interns and residents. t Estimated 97

108 Appendix IV (Cnt.) LATIN AMERICAN MEDICAL GRADUATES IN THE UNITED STATES, BY SCHOOL AND COUNTRY OF ORIGIN Cuntry and schl Number Ecuadr 65 Central University, Quit 49 Cuenca University, Cuenca Guayaquil University, Guayaquil 5 El Salvadr University f El Salvadr, San Salvadr Guatemala University f Guatemala Haiti 76 Schl f Medicine and Pharmacy, Prt-au-Prince 76 Hnduras University f Hnduras Mexic 9 Natinal University, Mexic City 6 Nuev León University, Mnterrey 85 Guadalajara University, Guadalajara 46 Schl f Medicine, San Luis Ptsí Military Schl f Medicine, Mexic City 6 Faculty f Medicine, Mérida Faculty f Medicine, Mrelia Schl f Hmepathy (Escuela Libre) 5 Schl f Hmepathy, Puebla Schl f Medicine, Oaxaca Autónma University, Guadalajara Schl f Hmepathy, Natinal Plytechnical Institute, Mexic City Puebla University, Puebla 8 Tamaulipas University, Tampic Veracruz University, Veracruz Nicaragua 9 University f Nicaragua, León and Granada 5 Sutheastern University, Granada Central University, León Panama 4 Natinal University, Panamá 4 Paraguay 4 Natinal University, Asunción 4 Peru 86 San Marcs University 86 Uruguay 7 University f the Republic, Mntevide 7 98

109 Appendix IV (Cnt.) LATIN AMERICAN MEDICAL GRADUATES IN THE UNITED STATES, BY SCHOOL AND COUNTRY OF ORIGIN Cuntry and schl Number Venezuela Central University f Venezuela, Caracas 4 University f the Andes, Mérida University f Zulia, Maracaib 6 West Indies University f the West Indies, Jamaica Frty-six ther schls O 99

110 Appendix V LATIN AMERICAN MEDICAL GRADUATES LICENSED BY EXAMINATION TO PRACTICE IN THE UNITED STATES, * Cuntry 96 96! 96 Grand ttal 9 47 Ttal excluding Ciiba 5 6 Argentina Tucumán University, Schl f Medicine, Tucumán Buens Aires University Córdba University, Córdba Litral University, Rsari La Plata University, Schl f Medical Sciences, La Plata Fur ther schls Blivia San Andrés University, La Paz San Francisc Xavier University, Sucre San Simón University, Schl f Medicine, Cchabamba Brazil Recife University, Recife, Pernambuc Schl f Medicine, Surgery, and Pharmacy, Bahia Fluminense Schl f Medicine, Niterói, Ri de Janeir Paulista Schl f Medicine, Sa Paul University f Brazil, Ri de Janeir Sa Paul University Paraná University, Curitiba Ribeiri Pret Schl f Medicine, Ribeira Pret Pará Schl f Medicine and Surgery, Pará University f Brazil, Schl f Medicine, Surgery, and Pharmacy, Ri de Janeir Faculty f Medical Sciences, Ri de Janeir University f Minas Gerais, Schl f Medicine, Bel Hriznte Eighteen ther schls Chile University f Chile, Santiag Cathlic University f Chile, Santiag Tw ther schls Clmbia Natinal University, Bgtá Antiquia University, Medellín Cartagena University, Schl f Medicine, Cartagena Javeriana University, Bgtá Valle University, Cali Tw ther schls * Number f licenses granted. Many persns are licensed in mre than ne state; hence, the number f individuals is rughly 5 per cent as great as the number f licenses O O

111 - Appendix V (Cnt.) LATIN AMERICAN MEDICAL GRADUATES LICENSED BY EXAMINATION TO PRACTICE IN THE UNITED STATES, Cuntry í4 Csta Rica University f Csta Rica, Schl f Medicine (new schl) Cuba Havana University One ther schl Dminican Republic Sant Dming University Ecuadr Central University, Quit Guayaquil University, Schl f Medicine, Guayaquil Cuenca University, Schl f Medicine, Cuenca El Salvadr University f El Salvadr, San Salvadr Guatemala University f Guatemala, Guatemala City Haiti Schl f Medicine and Pharmacy, Prt-au-Prince Hnduras University f Hnduras, Schl f Medicine, Surgery, and Pharmacy, Tegucigalpa Jamaica N infrmatin Mexic Michacán University, San Niclás de Hidalg, Mrelia Natinal University, Mexic City Nuev León Schl f Medicine, Mnterrey Guadalajara University, Guadalajara Scientific Institute, San Luis Ptsí Autónma University, Schl f Medicine, Guadalajara Tamaulipas University, Schl f Medicine, Tampic, Tamaulipas Natinal Hmepathic Medical Schl, Mexic City Sutheast University, Schl f Medicine, Mérida Libre University, Mexic City Puebla University, Puebla Military Schl f Medicine, Mexic City Nine ther schls Nicaragua University f Nicaragua, Granada (defunct) Oriente University, Medical Schl, Granada (defunct) Central University f Nicaragua, León Panama Natinal University f Panama, Faculty f Medicine I O O 4 5 4

112 Appendix V (Cnt.) LATIN AMERICAN MEDICAL GRADUATES LICENSED BY EXAMINATION TO PRACTICE IN THE UNITED STATES, Cuntry Paraguay Natinal University, Asunción Peru San Marcs University, San Fernand Schl f Medicine, Lima Three ther schls O O Uruguay O University f the Republic, Faculty f Medicine, Mntevide Venezuela Central University f Venezuela, Caracas Five ther schls

113 Appendix VI STATUS IN THE UNITED STATES OF GRADUATES OF THE UNIVERSITY OF BUENOS AIRES, THE NATIONAL UNIVERSITY OF MEXICO, AND COLOMBIAN MEDICAL SCHOOLS* A. University f Buens Aires Medical Graduates The fllwing data have been drawn frm a 965 sample f 4 physicians in six majr U.S. cities wh are graduates f the University f Buens Aires. It is evident that migratin t the United States is becming mre frequent. In the sample grup there were nly 6 individuals wh graduated prir t 94, whereas there were 4 wh graduated between 94 and 944, 6 wh graduated between 945 and 949 ( additinal persns wh graduated during this perid were taking residences), 6 wh graduated between 95 and 954 (plus 6 thers in residencies), and 8 wh graduated between 955 and 959 (nt including residents). There were 4 interns in Chicag but nly ne in all f the five ther cities cmbined. There was nly ne physician in residency training in Ls Angeles, but there were frm 7 t in each f the ther five cities. There were 9 practitiners in New Yrk but nly ne in St. Luis. There were 5 full-time faculty members in New Yrk but nne in either Chicag r St. Luis. There were research wrkers in New Yrk but nne in St. Luis. Of the 4 graduates, 8 were huse fficers (5 interns and 68 residents), 7 were in private practice, 7 were full-time hspital staff, 8 were full-time medical schl faculty, were engaged in research, and were in ther fields. The mst cmmn specialties fr the residents were general surgery (6), psychiatry (), internal medicine (), pathlgy (6), and pediatrics (5). Of thse in practice the mst cmmn specialties were general practice (4) and psychiatry (). Nt mre than ne practitiner was in any ther specialty. Of the 7 individuals wh were full-time hspital staff, the mst cmmn specialties were psychiatry (4), pediatrics (), and internal medicine (). Additinal infrmatin n this subject was btained frm AMA data n the number f licenses issued t medical graduates f the University f Buens Aires during the perid U.S. licenses were issued t Buens Aires medical graduates in 96, t in 96, t 4 in 96, t 54 in 96, and t 6 in 964. Nt all the licensees represented new additins t the prfessin, hwever, because abut 4 per cent f them already held a license in anther state. It may be assumed, then, that nly abut 6 per cent f the licensees were new additins. Prbably abut per cent f all physician immigrants frm Latin America are graduates f the University f Buens Aires. If Cubans are excluded frm the ttal, Buens Aires graduates amunt t almst per cent. B. Natinal University f Mexic Medical Graduates Data frm several surces make it pssible t rughly estimate the number f graduates f this schl wh have migrated t the United States in recent years. In 96, 48 graduates f the Natinal University f Mexic were licensed in the United States by examina- * Direct infrmatin, American Medical Assciatin.

114 tin, and prbably a few mre were licensed withut an examinatin. Since sme f these licenses were issued t persns wh had already been licensed in sme ther state, nly abut represented new additins t the prfessin. Frm these and ther data it wuld appear that abut 5 graduates f this schl have been migrating t the United States annually during recent years. Licenses were granted t 48 Mexic University graduates in 96, t 58 in 96, t 5 in 96, and t 48 in 964. The certifying examinatin f the Educatinal Cuncil fr Freign Medical Graduates, which was put int effect in 96, may have tended t limit the number f Mexicans pursuing internships and residencies in the United States. This in turn wuld tend t reduce the migratin rate. Thus it wuld appear that less than 5 per cent f the graduates have been migrating t the United States. In rder t evaluate the activities in the United States f the medical graduates f the Natinal University f Mexic, a sample f 99 physicians residing in six U.S. cities was studied. The distributin f the grup was as fllws: 8 were in Chicag, 5 in Ls Angeles, in St. Luis, in Bstn, and 9 in Philadelphia. In evaluating this infrmatin it shuld be kept in mind that the sizes f the medical establishments and the ppulatins f these cities differ significantly. Fr example, the ppulatin f the New Yrk area is abut 5 millin; Chicag, abut 6 millin; Ls Angeles, 5 millin; Philadelphia, 4 millin; Bstn, millin; and St. Luis, millin. Thus the relatively small number in New Yrk and the large number in Chicag are significant. General practice was by far the mst frequent specialty f the practitiners (5 ut f 4), whereas internal medicine was the mst cmmn specialty f the residents (7 ut f ). In Ls Angeles there were n interns r residents; f the 5 physicians in that city were in private practice. In Bstn, n the ther hand, nly ne f the physicians was in private practice, whereas 6 f the were residents. All thse in the sample grup wh graduated prir t 95 were in practice, whereas a substantial prtin f thse wh graduated between 955 and 959 were emplyed as full-time hspital staff (these were nt residents). Only 5 f these 99 physicians were pursuing academic wrk n a full-time basis. Three were members f medical schl faculties and tw were research wrkers. Hwever, it is quite likely that sme f the thers were ding sme academic wrk, particularly amng thse wh were full-time hspital staff, since sme f these hspitals undubtedly have interns and residents. The large number f graduates (9) practicing in Chicag is prbably attributable t the fact that many graduates f the Natinal University g t Chicag fr residency training. At the time f the study there were residents in Chicag wh were graduates f this schl. All these data suggest that in quantitative terms the lss f medical scientists and ptential medical scientists is relatively small. Prbably abut 5 per cent f these migrants are r will becme medical scientists. Therefre, if there are abut 5 migrants a year the lss f scientists r ptential scientists wuld average abut a year. C. Clmbian Medical Graduates Of apprximately 55 graduates f Clmbian medical schls in the United States, 4 are serving as interns and residents and are nt interns and residents. Of the wh are nt interns and residents, are graduates f the Natinal University at Bgtá, 6 are graduates f Cartagena, 9 are frm Javeriana in Bgtá, are frm Medellín, 9 are frm Cali, is frm Manizales, and frm Ppayán. The graduates f the Natinal University in Bgtá are widely scattered in 7 states: 4 in New Yrk, 5 in Illinis, 9 in Califrnia, 7 in Flrida, and 6 in Michigan. The Cartagena graduates are in 4 states: 9 in Illinis and n mre than in any ther state. The Medellín graduates are in 5 states, n mre than in any ne state. Of the 9 Javeriana graduates, are in New Yrk and the remainder are scattered in 8 ther states, with n mre than in any ne state. The 9 Cali graduates are in 9 different states. 4

115 Of the Clmbian graduates in the United States, nly ne graduated befre 9, 4 between 9 and 99, and between 94 and 949. Thus, the vast majrity have graduated since 95. Of the graduates f the Natinal University, 8 are in full-time specialty practice, 8 are in general practice with a specialty interest, 4 are "ther full-time staff in hspital service,"* 9 are full-time medical schl faculty, 5 are in labratry medicine r pathlgy, are in preventive medicine, and 7 are in research. Thus, a ttal f 6 are full-time academic wrkers (medical schl faculty r full-time researchers). Of the 6 Cartagena graduates, are in full-time specialty practice, are in general practice, are "ther full-time staff in hspital service," ne is in labratry medicine, and ne is in research. Of the Medellín graduates, 4 are in full-time specialty practice, ne is in general practice, are "ther full-time staff in hspital service," are full-time medical schl faculty, 4 are in labratry medicine, and is in research. Of the Javeriana graduates, are in full-time specialty practice, is in general practice, 4 are "ther full-time staff in hspital service," is a full-time faculty member, and are in research. Of the 9 Cali graduates, nly is practicing, 4 are "ther full-time staff in hspital service," is full-time faculty, are in labratry medicine, and I is in research. Of the Clmbian graduates in the United States wh are nt residents r interns, are full-time faculty members in U.S. schls and mre are mainly engaged in research. Thus, there are 6 in the United States wh are in full-time academic wrk. There are undubtedly a few mre in ther categries wh d sme academic wrk, such as research r teaching, but they are nt primarily engaged in academic wrk. The detailed list sent t PAHO gives the names, addresses, year f graduatin, year f birth, speciality, surce f incme, kind f wrk, and status f citizenship fr each f the 55 Clmbian graduates in the United States (4 interns and residents and wh are nt interns and residents). Between 958 and 965 the Natinal Institutes f Health awarded internatinal pstdctral fellwships t Clmbians fr study in the United States (an average f abut a year). In 964 there were Clmbians, plus U.S. citizens brn in Clmbia, being supprted by NIH training grants t U.S. institutins. Since these NIH training grants supprt abut half f the freign research trainees wh are physicians, it may be rughly estimated that there are abut bimedical research trainees in the United States wh are graduates f Clmbian schls. Visa status was knwn fr Clmbians in NIH training grant prgrams in 964. Five had immigrant visas and 7 had nnimmigrant visas. In 965, 8 physicians frm Clmbia entered the United States with immigrant visas. A large number f these were interns and residents. There is n infrmatin available cncerning the number wh had definitely decided t immigrate, but we knw that many f thse with immigrant visas have nt decided definitely t immigrate. Between 96 and 964 the number f Clmbian graduates wh received licenses t practice in the United States increased steadily. Abut half f these physicians are graduates f the Natinal University f Bgtá. A substantial majrity f thse wh receive U.S. licenses d immigrate. Thrugh examinatins in the varius states, 8 physicians were licensed in 96, in 96, 6 in 96, in 964, and 44 in 964. In 965 the number f licenses was, representing a slight decline. Of the licensees in 965, 4 were frm the Natinal University at Bgtá, 8 were frm Javeriana, 5 were frm Cartagena, frm Cali, and frm Medellín. Fr the 5-year perid beginning in 96, the ttal number f licensees by schl was as fllws: Natinal University f Bgtá, 8; Javeriana, ; Medellín, 4; Cartagena, 8; Cali, 5; and ther schls, nne. The number f licenses des nt reflect exactly the number entering practice in the United States fr a variety f reasns t cmplex t recite here, but the number f licenses is a crude index f the rate f immigratin. In very recent years prbably abut 5 * The categry "ther full-time staff in hspital service" indudes such peple as psychiatrists in state hspitals, full-time anesthesilgists, certain dinical and research trainees wh are nt called interns r residents even thugh they may be receiving pstgraduate training, and ther peple engaged in similar activities. 5