Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA.

BACKGROUND: Over 25 million US inhabitants are limited English proficient (LEP). It is unknown whether physicians fluent in non-English languages are training in geographic areas with the highest proportion of LEP people. Diversity of language ability in the physician workforce is an important complement to language assistance services for providing quality care to LEP patients. OBJECTIVE: To determine whether non-English language-speaking resident physicians matched in the geographic areas where language skills are needed. DESIGN: Cross-sectional study. PARTICIPANTS: Postgraduate medical training applicants to the Association of American Medical College's Electronic Residency Application Service in 2013-2014 (n = 50,766). We included data from the Graduate Medical Education Track database, mapped against American Community Survey data. INTERVENTIONS: N/A. MAIN MEASURES: We assessed the geographic alignment of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. KEY RESULTS: While 37% of resident physicians spoke at least one non-English language, in most cases the languages they spoke were not those in greatest need by the US LEP population. LEP speakers' potential exposure to non-English language-speaking residents varied. For Spanish, the language with the lowest national resident physician to Spanish LEP patient ratio, the ratio was most favorable in New York at 23.7/100,000 LEP population versus 5.1 in Los Angeles. For Tagalog, the group with the highest geographic mismatch, the ratio was 70.4 in New York but 0 in San Diego, San Jose, and Seattle. Among the top five LEP languages in the USA, Chinese-speaking resident physicians were the most geographically matched. CONCLUSIONS: We found considerable misalignment of the geographic distribution of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. Residency programs in areas of high need could consider better matching the non-English language needs of their community with the language abilities of the resident physicians they are recruiting.

Dreaming in Spain: Parental Determinants of Immigrant Children's Ambition.

We examine determinants of educational and occupational aspirations and expectations among children of immigrants in Spain on the basis of a unique data set that includes statistically representative data for foreign-origin secondary students in Madrid and Barcelona plus a sample of one-fourth of their parents. Independently collected data for both generations allow us to establish effects of parental characteristics on children's orientations without the confounding potential inherent in children's reports about parents. We analyze first determinants of parental ambition and, through a series of step-wise regressions, the effects of these goals and other parental and family characteristics on children's aspirations and expectations. A structural equations model synthesizes results of the analysis. The model confirms predictions from the research literature, especially those based on the Wisconsin status attainment model, but rejects others, including the predicted significance of private vs. public school attendance. Parental ambition, knowledge of Spanish by parents and children, gender, and children's age are major determinants of youths' educational and occupational goals. These results have direct implications for policy; these are discussed in the conclusion.

Coming of age in Spain: the self-identification, beliefs and self-esteem of the second generation.

We review the literature on determinants of ethnic/national self-identities and self-esteem as a prelude to examining these outcomes among a large, statistically representative sample of second generation adolescents in Madrid and Barcelona. While these psycho-social outcomes are malleable, they still represent important dimensions of immigrant adaptation and can have significant consequences both for individual mobility and collective mobilizations. Current theories are largely based on data from the USA and other Anglophone countries. The availability of a new large Spanish survey allows us to test those theories in an entirely different socio-cultural context. The analysis concludes with a structural equations model that summarizes key determinants of national identities and self-esteem among children of immigrants in Spain. Theoretical and practical implications of these findings are discussed.

Moving Ahead in Madrid: Aspirations and Expectations in the Spanish Second Generation.

This paper examines determinants of aspirations and expectations among children of immigrants based on a statistically representative sample of 3,375 second generation youths interviewed in 101 public and private secondary schools in metropolitan Madrid. We review the past literature on status attainment in general and aspirations and expectations, in particular, and draw from it a set of six hypotheses to guide the analysis. Most theoretical statements in this field have been developed on the basis of U.S. data; studies in other immigrant-receiving countries, especially outside the Anglophone world, have been scarce. The study thus provides an opportunity to test and refine existing hypotheses in a different national context. We present breakdowns of educational and occupational aspirations and expectations by gender, parental education and type of school attended. This is followed by multivariate regressions of all four dependent variables on these three plus other predictors suggested by the research literature. This analysis ends with structural equation models - recursive and non-recursive - that provide an integrated theoretical statement of the causal structure of ambition in the Spanish context. Implications of our findings for theory and policy are examined. Suggestions for future research in this field are discussed.