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are proposed, the junior college is carefully excluded even though in many, many instances, the junior college provides the lower division work and the State college or university the upper division work. There is a great deal of continuity in planning and in the curriculum available. Do you think under those conditions it is appropriate to exclude the junior college?
Dr. COON. I think you have an outstanding example of a junior college system in California. I think that if all programs were comparable we would not have quite the same problem. I think the real need, as I see it, in medical technology is for the better trained and by this I mean those who can become supervisors who can go on and do graduate work. We need really the teachers, the instructors; we need to improve the training facilities.
I would think in a situation where a junior college "feeds" into another institution so that a student can complete the 3 years of the preclinical work required and then continue the clinical training program, I think this should be considered an integral part of the total training process. I think that a 2-year program, where the individual completes his training within the 2-year program, trains a medical laboratory worker at a different level. By and large these persons need more continuing supervision.
Mr. Moss. You are talking about an institution as an institution for terminal education, where they complete the course and have an associate degree and the student goes out and takes employment? Dr. COON. Right.
Mr. Moss. At that level?
Dr. Coon. Right.
Mr. Moss. I am talking about the role of the junior college in providing a broader educational opportunity, aiding in attracting in the field of medical technology many students who have not the resources to start immediately at a university and frequently the junior college is able to accept the students who maybe are just marginal on being accepted at the university. In the University of California it is an A-B average. They will take them in the junior college system with a C under present conditions.
You have very high productive persons who maintain a C average through much of their life. It is not always in the interest of society to exclude them from opportunities to go on, is it?
Mr. Coon. No. If I understand your question, I am in complete sympathy with your thoughts here. I strongly believe that we should be training laboratory workers at the 2-year level, which would include, to my way of thinking, 1 year of general, cultural-type courses, preliminary courses, science courses, and 1 year which could be oriented as clinical training, laboratory oriented.
However, I do not believe that that same person could go on without considerable additional work and fulfill what I expect of a medical technologist, which is considerably more understanding of science considerably more aptitude and background in the various fields as well as the ability to accept more responsibility both for supervision of others, for recognizing abnormalities, appreciating the significance of findings, and having the responsibility to "follow through."
I think there are many people who are in this C level that do well. Mr. Moss. I think Winston Churchill was-most of his life-until he became a politician.
Dr. COON. That is correct. I do not like to see an absolutely terminal program where a person cannot go on.
We must work out ways for people to continue to advance and there have been several conferences here on that topic. I attended the conference recently held by the Department of Labor and HEW. There is a very real need to develop mechanisms so that we can encourage qualified people to go on and seek additional education so that they can accept these responsibilities.
Mr. Moss. Your statement on page 2 talks of the generously financed program at the junior college level, $1.3 million. Now really that is a very meager program even if they only applied the $1.3 million to the approximately 90 junior colleges in my State, is it not?
Dr. Coon. This refers to the training of cytotechnologists. There is $1.3 million for training cytotechnologists and the projection would seem to indicate that this may well be sufficient in order to meet the requirements as we anticipate them and as the need seems to be growing.
It does not cover the entire allied health field by any manner of
Mr. Moss. I would not want this record to reflect by a failure to speak out on my part any agreement with a statement which tends to infer that the junior colleges are not faced with serious financial problems because this normally is part of an educational system based upon revenues derived almost solely from the ad valorem tax levees. In my community at the moment where we support a system of three community colleges, the property owners are being asked to vote an additional override, to approve a level of tax in excess of that permitted by State law, in order to continue to meet the needs of our junior college system.
I would like to see, as we undertake programs to assist other institutions of higher learning, a recognition of the appropriate role. For instance, you point out the need to take many of these technologists back and give them courses upgrading their skills and their knowledge.
I believe in many of the communities with a good system of junior colleges that special courses could be provided there to meet the needs of the technologists in the area and I think that this type of flexibility and greater utilization is what we should attempt to achieve and not erect barriers in these programs and barriers created by the very narrow view of some of those now administering the programs which exclude this important and increasingly important part of our higher educational system.
Mr. FRIEDEL. Thank you, Mr. Moss.
Mr. YOUNGER. Thank you, Mr. Chairman.
I want to add my bit also in behalf of the junior colleges of California. With the shortage of facilities we have for the training we should utilize all of the facilities we have including the junior colleges.
I am particularly pleased to see you emphasize the necessity for the training of the teachers and the supervisors. To my mind you have to have those before you get the others.
On page 7 how do you interpret, "Families having an adjusted income of less than $15,000," to be eligible for a low-cost loan?
Dr. Coon. As I understand the Higher Education Act it provides for low-cost loans to assist students in acquiring their education where
the families have an adjusted gross income of less than $15,000. I interpret this to mean that it will be feasible for many students to borrow the money to acquire a complete education, the 4-year baccalaureate program, including students who in the past may not have been able to afford such a costly program.
I hope this will make it easier for students, including those in the allied health professions, to acquire baccalaureate-level educations. Mr. YOUNGER. But you understand that that is supposed to be changed now and converted to guaranteed loans?
Dr. CooN. Yes, sir.
Mr. YOUNGER. At a higher interest rate, in this legislation which you are recommending?
Dr. Coon. I had not understood that this would replace that existing legislation.
Mr. YOUNGER. That is the idea, to convert the direct lending to loans from the private sector on a guaranteed basis; you did not understand that?
Dr. Coon. I am not clear. As I understood there was some provision in there for a guarantee of the difference in the loan rates between the commercial sources and those from the Government; is that right? Mr. YOUNGER. I am like you; I am a bit confused about it myself. I am trying to get your understanding as a technician who will have to apply this, because the colleges are supposed to make these loans, as to what your interpretation of this bill is.
Dr. CooN. I think it is confusing.
Mr. YOUNGER. Do you think it ought to be cleared up a bit?
Mr. YOUNGER. On that same page you have a forgiveness of loans at the rate of 15 percent a year for 5 years for a total of 50 percent. I am a little confused over the calculation there. If you get a 15-percent forgiveness each year for 5 years, isn't that 75 percent? Dr. Coon. It would seem to multiply out that way. As I read it there was a 15 percent per year, it was increased from the previously recommended 10 to 15 percent.
Mr. YOUNGER. With a limitation of a maximum of 50 percent, is that the way you understood it?
Dr. CooN. Yes.
Mr. YOUNGER. That is not the way you stated it. You don't say there is a limitation. But a maximum of 50 percent forgiveness is all that they can have, is that your interpretation?
Dr. Coon. That was my interpretation unless they located in a poverty stricken area.
Mr. YOUNGER. This forgiving is for those who go into the practice in such areas which are considered as the areas where there is a great need for health facilities and represent more the poor rural areas as they call them.
I understand from the definition that Dr. Martin gave us that he understood that the bill provided that those areas were to be determined by the State medical authorities, not by the Federal authorities. And if they practice there for 5 years and you give them a reduction of 15 percent a year that would be 75 percent unless you put in a limitation. Now is it your idea that the forgiveness should be limited to 50 percent of the loan as it is in the National Defense Education Act and the Medical Facilities Act?
Dr. Coon. Yes.
Mr. YOUNGER. That is all, Mr. Chairman.
Mr. FRIEDEL. Congressman Mackay.
Mr. MACKAY. Thank you, Mr. Chairman.
I would like to address this question to both gentlemen. I have Dr. Godwin's letter which expressed concern about the language of the bill as not adequately taking care of the community hospital. Dr. Lee said he had had extensive discussions with you, Dr. Godwin, and you appeared to be satisfied with the language of the bill.
I would like to ask whether you feel that the language is adequate really to assure the use of the type of facilities which you represent because it seems to me if we are too strict in applying this to university related hospitals that we shall fail to provide what Dr. Coon said, enough opportunities for technologists in the actual hospital situation. Are you suggesting any amendment to this bill or do you approve the bill as it is now before the committee?
Dr. GODWIN. I made certain statements in reference to clarification of the bill by defining:
Equivalent degree as meaning or possibly meaning registration or certification under existing standards after 3 years of college and 12 months' internship which would satisfy the requirements in medical technology.
Also, if the bill were to be modified I made this statement:
Could the bill be modified to define the community hospital with approved programs as a training center and make the same grants available to those programs enrolling 20 or more students in various categories.
I thought this would truly stimulate the output of various categories of allied personnel and give direct support to the institutions training the greatest number of students thereby reducing hospital costs and providing better trained personnel where the need is greatest.
I thought there might be some problem in channeling money through a loose affiliation with the college or university as it is at the present time.
Mr. MACKAY. I would like to request that you confer further with the representatives of Health, Education, and Welfare on language because we have a situation now in our community under the Mental Health Facilities Act which we thought was a pretty good act last year but the regulations have become so restrictive that I have been told by the leaders of the State health department that we may not be able to really get some things going that need to get to going.
I think it is important that the law be so clear that we won't be confronted with regulations that in a sense defeat the very objective of the bill.
Dr. GODWIN. In our discussions this past Sunday, that is with Dr. Philip Lee, it was his understanding and interpretation of the bill that there would be great flexibility-this was a point that he madewhereby the community hospitals would participate through the affiliation with the colleges.
I think this would work with that understanding. I believe also he made this very clear in his remarks that it is not the intent of the bill to exclude the 2,650 students taking their 4th year clinical
training in the numerous community hospitals while affiliated with colleges and not administratively a part of the college.
This bill can work with this understanding. In my original thoughts about this bill I reflected this in reference to grants being made directly to the community hospitals because in the past community hospitals have not had the support necessary to obtain adequate space, microscopes, and other equipment necessary for training.
We have not had the funds to pay stipends to students for their living costs which may amount to $100 per month. And we have not had the funds to obtain teaching supervisors where these might be available.
So this is where I think we need some help in the community hospitals in order to do these things.
Now it can become very confusing as to the portion of a grant which is given to the college, as to how much of this might then go to the community hospital. It may be that the community hospital receives only two or three students in that particular affiliated college.
Well, this means a very small sum. This would be insignificant probably in an overall program. So, if the bill is modified then I would think that consideration should even be given to grants directly to the community hospital programs which have a sufficient number of students to make them what we consider a better school.
And we do have figures to show that schools which have a certain number of students perform better on the examinations, their enrollment is greater and they have fewer failures on the registry examinations, and now there is another small point that I just learned about in recent days and that is that the Veterans' Administration hospitals are being or will be supplied with funds to augment their training programs.
I have not seen this bill but I believe it is one that was presented by Mr. Teague. In this bill they planned to establish additional numbers of schools. Out of this the technology students will receive a stipend of $152 per month and this is above and beyond what we have been able at this time to supply students in our training program.
This then means that we will be again in a competitive situation with the Veterans' Administration hospitals so far as stipends to students are concerned. In Atlanta where we are constructing and completing a very large Veterans' Administration hospital the students would more likely lean toward going to a school where the stipend is greater.
In other words, in comparing a stipend which I have to offer at the present time of $80, per month, it is likely that the student would prefer the $152 per month.
Mr. MACKAY. I would like to again state that if you will consider what language might be explicit without being too rigid, I would like to see this offered by way of amendment.
Dr. GODWIN. Are you suggesting modification in reference to the
Mr. MACKAY. The community hospital, with regard to the matters you mentioned in your statement.