unsuccessful for years in raising new costruction funds have found the necessary stimulus in a partial cost grant under the new health research facilities grant program.

We are confident that this experience will be repeated if the Congress enacts legislation authorizing Federal matching grants for medical and dental teaching facilities. State legislatures, school trustees and alumni, voluntary associations, and individual donors will respond to this new stimulus with considerably more non-Federal funds than previous fund-raising campaigns have produced. As a result, the primacy of State and local initiative and responsibility for construction and for the increased operating costs resulting from new schools or expanded enrollments will receive a new and much needed emphasis.

In brief, Mr. Chairman, our proposal does not represent any Federal attempt to centralize or to take over the burden of financing medical and dental education. Rather, it reflects our conviction that the exceptional current needs for new or modernized facilities require that Federal aid be provided to stimulate and supplement an increased effort by non-Federal donors. We believe that the limited and shorttime aid authorized in our proposed legislation will neither interfere with the essential independence of the schools nor undermine their primary reliance on non-Federal sources for the increased revenues they will require to meet the Nation's needs for professional health personnel.

Thank you.

Mr. WILLIAMS. Dr. Darley, would you prefer that you go ahead with the statements of the various members of your panel before we interrogate the individuals, or would you feel that we should go ahead with the interrogation of the witnesses as they appear?

Dr. DARLEY. We would like to do just as you wish, sir. It would be nice to complete the record first, however, before the questioning. Mr. WILLIAMS. You feel it would be better procedure, then, to permit your group to conclude before we begin questioning?

Dr. DARLEY. I think it would be preferable, if that is all right. Mr. WILLIAMS. All right, sir. I am sure that would be agreeable with other members of the subcommittee, unless somebody raises an objection; and I do not think they will.

STATEMENT OF DR. L. E. BURNEY, SURGEON GENERAL, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Dr. BURNEY. Mr. Chairman and members of the committee, it is always a pleasure to appear before this committee and to have the privilege at this time of discussing what we believe to be very important legislation, both extending the present research construction facility activities, and adding to that the legislation for grants for teaching facilities.

I think, as the primary health agency, that this committee and the Congress have always felt that we should bring to you our assessment of the national health needs and those particular problems with which the Congress is concerned and in which it has a natural interest. Also, I think we have a responsibility through our research, both intra

mural and extramural, as well as our operating, perhaps, to bring to you some of the problems we see there which are of national interest. Finally, as the agency which you designated in your legislation to administer the 3-year program, title 7, for the construction of research facilities, we have some observations and experience which I think may be helpful to you.

As you recall, the Health Research Facilities Act of 1956 is administered by the Public Health Service with the advice of an Advisory Council consisting of 12 individuals-4 public members and 8 scientific members and a representative ex officio from the National Science Foundation.

You also requested in this legislation that we submit to the Congress an annual report of the progress being made under this legislation and also directed that at the end of the second year of this program, we submit not only an annual report but also an assessment or an appraisal of this program and its adequacy or inadequacy to meet the long-term needs for research in the sciences relating to health. I would like to emphasize particularly in the sciences related to health. You may recall that this very committee was the one that broadened the initial legislation which in the beginning related only to physicians and dentists, as I recall. This committee brought up the fact that there are other members of the health profession-biologists, biophysicists, biochemists, and other professional groups-who have an interest and a contribution to make in research. So this committee did broaden the initial legislation as proposed, and we have found that an extremely important fact in this legislation.

We submitted to the Congress this January House Document No. 324-I think all of you have had a copy of this to the President of the United States, and he in turn submitted it to the Congress. I would like to call attention to a few of the important points in his report which bear on the legislation you are now considering.

First, it was clearly evident, both to those of us in the Public Health Service who worked on this program and to the members of the advisory committee, that the 3-year program for matching grants for research construction facilities is inadequate. The volume of approval applications has far exceeded the availability of funds.

Also, I think you would be interested to know that although the matching requirements under this legislation require only $1 for $1 matching, actually up to the present time, at least, we have had about 2 to 22 times local funds to every dollar of Federal funds, although, as I say, the matching could be 50-50.

At the present time, we have about $71 million of approvable projects pending for consideration by the Council, and larger amounts which the medical and other university groups and research foundations have indicated they would like to apply for if funds were made available.

The report to the Congress recommended very strongly the extension of this matching grant program for research construction facilities. Second, the report makes another recommendation which I would like to read to you which bears upon the second matter before this committee, and that is the extension of this act to include matching grants for teaching facilities and medical, dental, and related schools.

28728-58——7

I would like to quote here:

We are convinced that if we in America are to get on with the problems of expanding health research and of improving the health of the American people, the artificial separation of education and research should be dropped and aid given for both. Hence, it is our recommendation that legislation be enacted to authorize a program for construction facilities for the training of personnel in health-related fields, as well as for construction of health research facilities. It is further recommended that program be administered as one with review and advice by one council.

So the Council, together with me as Surgeon General, have recommended the extension of the present program, the expansion of the program to include teaching facilities, and the administration of the combined programs with the assistance of a single council.

The bills which are before you, I think, are basically consistent with these recommendations. One of the bills calls for a dual advisory council through 1959, but then a joint council after that. All the others carry out the basic recommendations that I have mentioned here. The bills do differ somewhat in the dollar amounts, in the matching requirements, in the earmarking for special purposes, but all of these proposed bills do agree on basic program objectives and the approach.

We believe, Mr. Chairman, very firmly that the basic pattern of the legislation which you enacted in 1956 has proven to be very sound and workable. The nature and distribution of medical and dental schools do not lend themselves, as you determined in your previous deliberations, to the allocation and matching formulas, for example, that we have in Hill-Burton and other activities, and for the matter of State plans and joint Federal-State machinery for administration. Also, I am extremely proud, Mr. Chairman, of the work of this Advisory Council which is provided for. These are all men with full-time positions, important positions in either industry or the sciences, and yet they have given a tremendous amount of time not only to the Council meetings, but to projects like visits throughout the country; and I think that accounts, too, for the equitable distribution of these present funds for research construction facilities and for the very discriminating reviews of these projects that have come in.

I think there is no question but that, as I said before, they have stimulated local matching funds; and someone else, I think, said yesterday that the exact amount or percentage of Federal funds is not as important or is less important than that there is available so much matching fund grant assistance.

In conclusion, Mr. Chairman, I would like to say again that we have felt that this present program has been a very worthwhile activity; that it is and has been in the national interest; that we are concerned with improving and expanding research throughout the country for the benefit of all of the people in our States and Territories; that the two greatest bottlenecks for expanded research at the present time are these: (1) adequate facilities in which to construct research; (2) personnel to carry on research. Those are the only two bottlenecks that we have to a greatly expanded research program.

Again, I would like to state that it is not only the lack of medical personnel but it is the lack of other scientists in related groups.

For these reasons, we believe this legislation already enacted and this request to expand this legislation to teaching facilities are needed in our expanding economy and in the health needs of the country as a whole, that they are in the national interest, and as such are a proper concern for the Congress.

Thank you, sir.

Dr. DARLEY. Mr. Chairman, in 1956, the Association of American Medical Colleges adopted a statement which expressed the feeling that we need to increase the number of health service personnel, and that in connection with this we need it to strengthen our schools and establish new schools. I will not go into detail beyond that.

Then, in 1957, after a study had been made of the number of vacancies in the junior classes of our medical schools, a statement was approved to the effect that there was room for several new 2-year schools of medicine in the United States so that the sophomores that would finish these programs could fill these vacancies that had developed in the 4-year programs over the country. We found that there were between 300 and 400 such vacancies.

So here is one way of increasing the output of physicians to some extent without going to the expense of establishing 4-year medical

schools.

Mr. DINGELL. Doctor, would it not also be easy to expand those 2-year medical schools later into 4-year medical schools?

Dr. DARLEY. Yes, sir. That is where our 4-year programs come from. Briefly, Alabama, Mississippi, West Virginia, and Missouri, have recently gone from 2- to 4-year programs.

Mr. WILLIAMS. I think it should be in all fairness stated that they have done it with State funds, not with Federal help.

Dr. DARLEY. Yes, sir. This is one reason for the vacancies in the junior classes, because these schools are no longer transferring students.

Then, in 1948, the association passed a resolution favoring the type of legislation that is under consideration today, and we have a communication from the American Council on Education, indicating it is favorable to the legislation under consideration. Then, I am introducing a group of selected letters from the deans that describe in a general way what their problems are.

Mr. DINGELL. Mr. Chairman, would it be possible to have those documents to which Dr. Darley has just referred inserted in the record?

Mr. WILLIAMS. Is that all that you have, Dr. Darley?

Dr. DARLEY. Yes.

Mr. WILLIAMS. Surely.

Mr. DINGELL. I would very much like to see them in the record. Dr. DARLEY. It was my intention that they be offered for the record. Mr. DINGELL. That would include the resolution going back to 1956 that you referred to, of the Association of American Medical Schools? Dr. DARLEY. Yes, everything I mentioned.

Mr. DINGELL. That is all in the record?

Dr. DARLEY. Yes.

Mr. DINGELL. Thank you, sir.

(The material referred to above is as follows:)

STATEMENT ON THE FUTURE NEED FOR PHYSICIANS BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES

(Passed unanimously, Association of American Medical Colleges, October 1956) The changing nature of our industrial civilization, the increasing population, and the expanding knowledge revealed by research have and will continue to have a profound effect on our educational programs. It is a responsibility of the universities and of the professions to recognize and meet the needs of society. There is no area in which this obligation is greater than in the field of the health sciences.

Within the next decade, the health care of the American people based on greater knowledge through research will require increasing numbers of all types of personnel including physicians. Further, many more young men and women will be seeking higher education and training in one of the health professions. In the 10-year period (1945-46 to 1955-56) since the end of World War II the number of medical schools has increased from 77 to 82, the number of entering freshmen from 6,060 to 7,686, and the number of graduates from 5,655 to 6,485. Two new medical schools admitted a freshmen class for the first time in the fall of 1956. At least one other school is in process of formation and will admit its first class in 1959.

Although the Association of American Medical Colleges is proud of this record of the medical schools in responding to the needs of the postwar world, it also believes that more remains to be done. Medical education should be expanded further without impairment in the high quality which has been carefully built up in the United States since 1910. It is possible that some existing schools can, with new facilities and larger facilities, accept additional students, but the need will not be met completely in this manner. The larger contribution in number of students will come, as it has in the past, by the establishment of new schools.

On the other hand many schools have already expanded their enrollment without increase or improvement of physical plant. The 84th Congress authorized construction of research facilities, but as was pointed out by the President, this met only a part of the need to maintain the present quality of teaching for the present number of students.

The Association of American Medical Colleges urges its member institutions to survey their potentialities and capacities in the light of the future need for health personnel, and urges universities in large urban centers, now without a medical school to give serious consideration to the establishment of one.

The latent period between the determination to form a medical school and service of the graduates to the people is 8 to 14 years; 2 to 4 years to plan the program, construct the buildings, and secure a faculty; 4 years for medical education and 2 to 6 years for hospital training as an intern and resident. Hence, if we are to meet the problem, it should be borne in mind that plans made in 1956 are not for next year or the year after, but for the needs of the Nation in 1964-70.

A program of expansion will require large sums of money, both for capital expenditures and for operating expense. The Association of American Medical Colleges is dedicated to the preservation of joint and coordinated support of medical education from private and Government sources and believes the American people are willing and able to back ventures which will mean better health and a happier life.

STATEMENT REGARDING 2-YEAR SCHOOLS-PASSED UNANIMOUSLY, ASSOCIATION OF AMERICAN MEDICAL COLLEGES, ATLANTIC CITY, N. J., OCTOBER 22, 1957

At its 1956 annual meeting, the Association of American Medical Colleges issued a statement to the effect that this country should increase its output of physicians by increasing the number of its medical schools.

As things stand now, after making allowance for the four new schools in development, it appears that between 1957 and 1964 our annual number of medical graduates will increase by approximately 450 to 7,400. In the opinion of the association, exploration of means beyond additional 4-year schools for further increases for the period after 1964 is necessary.