progress has now reached the critical point that unless some modicum of outside assistance can be obtained for the medical school, Puerto Rico will be unable to develop fully either its state or international medical potentials. It has been traditional until 1950 for students to go to the mainland of the United States for their medical studies. The establishment in that year of a school of medicine was possible of undertaking because a school of tropical medicine had been functioning for some 25 years. This provided a building and the nucleus of the staff, budget, library, and other essentials for the basic sciences departments. Clinical facilities were provided through the San Juan City Hospital, which is a series of old buildings located over 3 miles from the medical school building. Since 1950, four classes totaling 175 graduates have received the medical degree; the curricula in public health have been expanded to the point where nearly a hundred public health students (mostly graduate) are enrolled annually; the research program has been extended enormously (55 research grants currently make available $750,000 of outside support and teaching grants provide an additional $200,000 annually), a dental school was opened in August of 1957 with plans for 40 students in the first year class; a variety of postgraduate programs have been initiated in such fields as psychiatry, aphthalmology, parasitology and tropical medicine, arthritis and metabolic diseases, as well as public health. A gradually increasing emphasis in research in nuclear aspects of medicine has been initiated. These modest achievements have been accomplished without any increases in space and literally the school of medicine, school of public health and school of dentistry are bursting at the seams. This handicap plus the physical separation of the basic science and clinical faculties provide very real difficulties to the normal development of educational and research programs. Recently long range plans have evolved for the new Puerto Rico Medical Center, of which the school of medicine is to be the hub. Also, this center will be the base for the new regional organization for more efficient distribution of services and of training throughout Puerto Rico. It is to be recalled that "regionalization" was the second objective of the Hill-Burton Act. Puerto Rico is the first state to institute comprehensive regionalization. The center is situated 2 miles from the university and in close proximity to an 1,800-bed psychiatric hospital, one a tract of 105 acres of land currently occupied by two new units of tuberculosis hospitals and many older units. The program involves conversion of the new adult tuberculosis hospital into a 500-bed general hospital to serve as both the base insular and a regional hospital for the department of health, and to become the principal teaching hospital of the school of medicine. This hospital will be connected by a central service building to the new 600-bed San Juan City Hospital, which is a planned replacement for the current principal teaching hospital. The central service building will also connect with a new 300-bed industrial hospital (State insurance fund) and a 100-bed cancer hospital (Liga Contra el Cancer) and also to the medical science building (school of medicine, public health, and dentistry). Without any allowance for housing of students, interns, residents, and so forth, approximately $27 million will have to be spent to achieve the above-mentioned objectives. The entire allotment of Hill-Burton funds that might be anticipated would not cover the planned hospital installations. Therefore more than half of this total amount will have to be raised from non-Federal sources. This places the school of medicine in a highly competitive position for funds from the Commonwealth, for its construction needs. On the other hand, if Federal legislation were passed providing matching funds for schools of medicine, dentistry and/or public health, the chances for advancement of planning would be greatly enhanced. Preliminary estimates indicate that $7 million will be needed for the medical sciences building (medicine, dentistry, and public health) while no request as yet has been made to the Commonwealth legislature it is logical to assume that they would be favorable to such a plan since the current building, although completely inadequate for the total needs, would provide a substantial office building immediately adjacent to the State capitol building and its new annexes which house legislative facilities. The foregoing indicates the critical space situation of the school. Federal legislation if passed to provide matching funds would permit the immediate expansion of needed educational and research facilities. Entering classes could be accepted of over 65 medical students, not less than 40 dental students, 30 candidates for the master of public health, 20 candidates for the master of health education, 15 candidates for the master of sanitary science, 25 public health nurses, 15 in nursing education and 12 in psychiatric nursing, 40 in medical technology, and an entering class of 25 in physical and occupational therapy, together with an eventual potential of 75 entering a degree program in nursing. The current plans for graduate students in the basic medical sciences (including nuclear medicine) would gradually expand to accommodate from 30 to 40. The intern and resident training program in the medical center would total approximately 100 and 200, respectively. Thus the entire medical center would be providing training for about 250 medical students, 150 dental students, 250 public health and paramedical students, plus 300 nurses, 100 interns, and 200 residents, plus 35 graduate students or a total of 1,285. The undergraduate medical and dental programs are planned to resolve the problems of training personnel needed within Puerto Rico. In summary, the present limited space in the basic science building permits no further expansion. The construction of the new medical science building is essential to the fulfillment of the modern medical center concept, and will bring together for the first time the complete medical faculty. The latter, would not only meet the professional personnel needs of Puerto Rico; but as important would become a demonstration whereby such a center would serve as the base for a statewide regional system of distribution of services and of training facilities. The significance of the latter would be as much international as national. STATE UNIVERSITY OF SOUTH DAKOTA, SCHOOL OF MEDICINE, Vermillion, January 23, 1958. To: Dr. Ward Darley, executive director, Association of American Medical For Presentation to congressional committees concerned with Federal construction funds for medical education and research. Subject: Federal construction funds for medical and dental schools. The present building occupied by the several basic-science departments of this school was originally planned in 1949, following legislative appropriation. For reasons which need not be detailed, a considerable delay ensued before contracts for construction could be let. This spanned the period of the outbreak of the Korean war, with it came considerable rise in building costs. Necessarily, then, the initial plans had to be curtailed somewhat, so that the present building is somewhat less what had originally been contemplated to accommodate a medical class of from 40 to 44 students. Since 1949, the staff has more than tripled in size, and research activities, virtually nonexistent in the school prior to 1949, now make up almost one-third of the total budget operation of the school. During this same period, a considerable expansion in graduate-student programs has occurred, which has paralleled the research interest and activity displayed by the faculty. The aforementioned factors have served to considerably restrict the activities of the staff, both as it applies to medical-student research activities, the graduate research program, and the individual investigative efforts of the staff itself. Also, each year finds additional demands for services from a variety of interested agencies and professions in the State, many of which have yet to be implemented through space limitations alone. In summary, then, additional building space would permit not only the full utilization of the professional talents of the staff in reference research activities, but it would also enable an extension of medical services to the public, with ultimate benefit to their health and welfare. A recent survey of the three most space-limited departments in the school suggests that an addition embracing some 13,000 square feet of floorspace could be immediately occupied with the advantages suggested in the aforementioned paragraph. Such an addition could be supplied at an estimated cost of between $150,000 and $175,000. It is unrealistic for us to believe our State is in a position to make this entire contribution, even though I am sure officials would accept the fact that it may be their first responsibility. Facing the matter realistically, the medical school is only one division of a university, and each of the several schools do, in a large degree, have similar problems at this time of expanded enrollments. It is incumbent on us, then, to recognize that, looking at the larger picture of university educational activities in general, all must have equal opportunities if growth and progress are to be achieved in an orderly manner. Insofar as this applies to the State of South Dakota, the medical school has been fortunate in being the first of several schools represented on this campus to have its own teaching facilities granted by the State in recent years. It is reasonable, then, that the limited State moneys available for construction should be directed now to other critical areas. It is a case, then, of insufficient funds available at a local level to accommodate the needs of all. It should also be recognized that a basic-science school is subserving an extremely prominent place in the training of doctors, not alone for a State, but for its Nation. Viewed in this light, it would seem logical that the Federal Government give particular attention to those areas of need which so directly affect the welfare of its citizenry as does medical education. Sincerely yours, WALTER L. HARD, PH. D., Dean. MEHARRY MEDICAL COLLEGE, SCHOOL OF MEDICINE, Nashville, Tenn., January 21, 1958. Dr. WARD DARLEY, Executive Director, Association of American Medical Colleges, Evanston, Ill. DEAR DR. DARLEY: In recent weeks, I have made a detailed restudy of the space needs in the School of Medicine of Meharry Medical College. The plant which we now occupy and which houses the schools of medicine, dentistry, nursing, medical technology and the divisions of dental technology and dental hygiene, was occupied first in 1931. At that time, there were 16 full-time teachers on the faculty of the school of medicine. Last year, 1957, the full-time faculty in the school of medicine numbered 40. These full-time teachers were assisted by 43 technicians and secretaries and by 21 residents. The average size of the entering classes in the school of medicine was 58 during the 1930's. The graduating classes averaged 40. During the 1950's, the classes average 65 upon entrance and 62 at graduation. In a rough way, this indicates the need for increased space. More bodies are occupying the space which has remained substantially unchanged in size for over 25 years. A survey, made on a departmental basis, shows a need for 38,907 additional square feet of space. This addition would allow us to increase the size of our entering classes in the school of medicine to 80. Some alternative solutions to our space problems have been considered: I. BASIC SCIENCE AREAS (a) Increase in the size of teaching laboratories in the traditional way with corresponding increase in teachers' offices, etc. (b) Two multipurpose basic science laboratories. (c) Traditional laboratories for the freshmen, a multipurpose laboratory for the sophomores. II. CLINICAL AREAS (a) Conversion of some of the space vacated by the basic science laboratories. (b) New construction for clinical instruction. In addition to the fundamental needs in the preclinical and clinical areas, it is recognized that our needs as an institution include space for the following: (1) An auditorium. (2) An audiovisual department. (3) Offices for administrative officials. It is my opinion that the greatest good would come from a plan which included: 1. Two multipurpose laboratories, each of which would accommodate 80 students. 2. Expansion of all clinical departments. 3. An auditorium, modernly equipped. 4. Centrally grouped offices for administrative officials. The estimated cost is $1,124,600. 28728 0-58- -15 These needs are real and the estimates were arrived at from a detailed study made within the last 90 days. However, the problem at Meharry will not be solved by any bill which requires matching funds, especially on a 50-50 basis. We have no resources which could supply $600,000 on comparatively short notice. We sincerely believe we could perform a more useful function in the field of medical education if we had the facilities. If you think that copies of the data from which these conclusions were drawn would be useful, I should be glad to send them to whomever you designate. Yours very sincerely, D. T. ROLFE, M. D., Dean. GENTLEMEN: I am Dr. John B. Youmans, dean and director of medical affairs, Vanderbilt University School of Medicine, Nashville, Tenn. I have been engaged in medical teaching and research for over 35 years and in medical administration for the last 12. I am the immediate past president of the Association of American Medical Colleges, and am familiar with the present situation of medical education and the medical schools of the country. However, I wish to confine my discussion today to that of my own institution, the School of Medicine of Vanderbilt University. Vanderbilt Medical School was founded in 1876, and is the only private medical school between the Great Lakes on the north, New Orleans on the south, St. Louis on the west, and the seaboard on the east. It accepts students from everywhere, and its graduates are engaged in the practice of medicine throughout the United States. It has produced and is producing a relatively large number of medicalresearch workers and teachers. It is entirely dependent for its operation and maintenance on its endowment, tuition, and gifts from alumni and others. It does not receive a cent of tax money for its educational program, except a small amount in the form of Federal restricted teaching grants, common to nearly all medical schools. The research grants from Federal agencies provide less than the cost of research performed under these grants. At the time of its reorganization and the construction of the present plant some 30 years ago, the operating income of the school, all from private sources, was reasonably adequate. In the succeeding years, the school spent freely from its funds in providing a high standard of medical education. However, beginning some 20 years ago, with rising costs, diminished income and purchasing power, and the need to add personnel, equipment, and facilities to make and maintain the advances in medical education and research, the school has encountered increasing difficulty in maintaining its operation. This has been particularly true in the last 5 years, following the great increase in costs after the Korean war and the requirement of teaching in the day of tremendous advances in the field of medicine. Aside from the problems of salary and other operating costs, in themselves of greatest importance, the physical plant, now nearly 40 years old, has deteriorated and become outmoded and inadequate. To a considerable extent, this has resulted from the need to divert funds to meet operating needs and the consequent inability to provide protective maintenance and replacement reserves. The same has been true, even, of vital equipment. The critical situation of the school could be discussed at length, but perhaps 3 or 4 examples will serve best to illustrate the situation. The power-supply cables and electric wiring became so inadequate and obsolete that, a year ago, it became impossible to add a single piece of electrical equipment because of the threat of power failure and even more serious results. It became necessary to draw on endowment funds to remedy this, with, of course, a resulting decrease in income. The still which supplies distilled water to all departments and laboratories, a vital need for all teaching and research, has failed beyond repair after nearly 40 years of service. No funds are available for its replacement. An inadequate makeshift arrangement to secure supplies from the hospital is necessary. The coldroom required to house cadavers for dissection has deteriorated so badly that it is not usable and has been condemned. No funds other than from further inroads on endowment capital are available for repair or replacement. Finally, this inability to repair, modernize, and expand the plant has prevented an increase in the number of students enrolled. The medical school recognizes its obligations to our country to increase their output of doctors, provided their facilities permit. Plans to increase the number of students by 50 percent depend on modernization and expansion of the present plant. Such plans call for funds in the amount of $5,640,000. It is because of the situation I describe, and one which I believe exists in many other medical schools. that I urge the passage of H. R. JOHN B. YOUMANS, M. D., Dean. FINAL DRAFT OF PRESENTATION TO THE CONGRESSIONAL COMMITTEE NOVEMBER 20, 1957. GENTLEMEN: I am Dr. George A. Wolf, Jr., dean of the University of Vermont College of Medicine and have been for the past 51⁄2 years. May I call your attention to certain important facts about the University of Vermont College of Medicine which relate to favorable action on H. R. The medical school has been in almost continuous existence since 1804 and is the only fully accredited 4-year medical college in New England north of Boston. Over half of our living graduates are engaged in pursuing the practice of medicine or medical endeavor, outside of the State of Vermont and from coast to coast and overseas. One of our graduates is a brigadier general in the Air Force Medical Corps and another holds a similar rank in the Army Medical Corps. Only one-third of our approximately 200 students in the college are Vermont residents. Nevertheless each person in the State of Vermont (there are only 370,000) has seen fit through the legislature to contribute $1.40 toward the operation of the college of medicine annually. This contribution represents about 55 percent of our budget, the remainder being raised from tuition, gifts, endowment grants and the modest beginning participation of other New England States by way of the New England Board of Higher Education (exhibit I). Two years ago we attempted to assess the medical needs of the upper New England area and among other things found that Maine and New Hamsphire were preparing considerably fewer doctors for the future than was the country at large. That this problem has been recognized is evident from the establishment not only of the New England Board of Higher Education in the general education field but also by the legislative recognition of Maine, New Hampshire and Vermont of the regional medical needs board established at the instigation of the University of Vermont College of Medicine (exhibit 2). Their opinion concerning Federal aid to medical college construction is represented in a copy of the resolution here attached signed by the members of this board. Looking at our 55-year-old, 40,000-square-foot main building, our 150-year-old wooden annex, our utilization for research of patient space in our two affiliating but private voluntary hospitals, feeling concern at having to assign an assistant professor to a converted coalbin for a research laboratory (this emotion rapidly changed when I found an associate professor doing research in a broom closet), we had little hesitation in obtaining professional help in planning for our new approximately $8 million college of medicine building and seeking the funds for it. To date from our 1,400 living alumni, including graduates of 1893, interns, residents, and those serving in the Armed Forces we have raised about $600,000 in cash and pledges and have obtained a grant of $619,000 from the Health Research Facilities Construction Division of the United States Public Health Service. On October 28 we broke ground with the blessing of our trustees for the first phase of our new building to be used for clinical and pathological research. Still somewhat short of cash to meet the payments on this only one-eighth of the whole program but full of faith we must look to completion of the entire $8 million structure if we are to expand our student body when the anticipated increased number of young people in northern New England start clamoring at our doors. (We now have 425 applications for each of the 50 places in our first year.) Assuming we have $7 million left to go, how can we expect Vermont, with a limited total annual State budget, to provide the funds? We have personally visited 17 major foundations to date and have been turned down because we are seeking bricks and mortar and/or because we are a Statesupported school. |