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(The document referred to follows:)
PAUL G. ROGERS,
Rayburn House Office Building,
House of Representatives, Washington, D.C.
MARCH 29, 1966.
DEAR CONGRESSMAN ROGERS: In today's hearings before the Interstate and Foreign Commerce Committee on H.R. 13196, the Allied Health Professions Personnel Training Act of 1966, there was considerable discussion as to whether the proposed legislation should be broadened to include Federal support for programs below the baccalaureate level, and specifically at the level of the junior college, since so many thousands of health-related technicians are being trained in these institutions and new programs are being rapidly developed in most parts of the United States.
In the testimony of the Secretary of Health, Education, and Welfare, John W. Gardner, on page 5, Mr. Gardner stated that "substantial" Federal aid is being made available at the subprofessional level to train health occupations personnel, through the Vocational Education Act. He stated that some 56,000 persons are being trained annually in such areas as practical nursing, nurses aids, dental assistants, medical assistants, and laboratory assistants.
During questioning by yourself and other Members of Congress, Mr. Gardner continued to support the statement that vocational education is providing for this level of training at the junior college, and that, therefore, this new program should "fill the gap" which exists at the baccalaureate level.
In response to questions after the meeting by yourself and by Mr. Robert Smith of your staff, I am submitting the following information on this subject, which was furnished to me today by personnel of the Bureau of Adult and Vocational Education of the Office of Education.
The picture, in brief, is that only a few people are being trained at the junior college or equivalent level with vocational education funds, that most of these being trained are in practical nursing, that many are part-time people who are taking upgrading courses, and that very limited Federal funds are available in any case. What is more, I am told by State officials who administer junior college programs that in many States junior colleges receive little-or no vocational education funds for health-related programs or any other programs. The bulk of the money goes to the secondary level, and many of the State boards appear to be secondary school oriented. The Federal law is permissive, not mandatory, and leaves it up to the State board whether to include junior colleges or other postsecondary institutions.
To cite a few statistics: For the fiscal year 1964, the most recent year on which there is reasonably good information, about 67,000 students in health-related curriculums were partially supported by VEA (Vocational Education Act) funds. About 42,000 of these students were enrolled on the postsecondary level and about 15,000 on the secondary level.
About 32,000 of the 42,000 postsecondary students-about three-fourths-were enrolled in practical nursing courses. This means that only about 10,000 students in the whole United States were partially supported by Federal funds in any other health-related field at this level.
What is more, many of the 42,000 students were part-time students, adults who are employed and taking a few courses. While the Office of Education did not have exact information, it appears that most of the 16,000 or 17,000 part-time students were postsecondary, which means that still fewer people are being trained in any curriculum at this level.
Funds are limited. In that fiscal year, $4,760,000 in Federal funds were made available for training these 67,000 students. If they were all full-time students, this would provide about $70 per student per year. Assuming a reasonable course load for part-time students, the figure might rise to $88 per student per year. This figure of $70 to $88 per year must be compared with costs per student which may run to many hundred dollars per year, and to the suggested formula of $500 per student which would be provided by the proposed legislation, in addition to funds per curriculum of $5,000, and other funds available under other titles of the bill.
In other words, baccalaureate students are to be supported at $500 plus per student per year, while junior college students may possibly be supported at a figure of $70 to $88.
The data for fiscal 1965 is not complete but indicates the same general pattern. It is also important to emphasize, once again, that the Vocational Education Act permits, but does not require, a State to make funds available at the junior college or other postsecondary level. In the fiscal year 1964, again the latest for which there is reasonably complete information, Federal VEA funds amounted o $18,645,020 for secondary education support and $4,600,117 for postsecondary support-a ratio of about 42 to 1.
Similarly, in that year the Office of Education estimates that 2,140,756 students were enrolled in federally aided VEA programs at the secondary level and only 400,485 at the postsecondary level-a ratio of over 5 to 1.
In many States, very little VEA money was spent at the postsecondary level, and very few students were enrolled. For example, in New York in that year about 230,000 secondary students were partially supported by VEA funds, but only 17,000 postsecondary students. The comparable figures for a few other States: Florida, 90,000 secondary, 16,000 postsecondary; Illinois, 75,000 secondary, 12,000 postsecondary; North Carolina, 108,000 secondary, 24,000 postsecondary; Virginia, 66,000 secondary, 7,000 postsecondary; West Virginia, 20,000 secondary, 852 postsecondary.
Three other points must be emphasized in analyzing these statistics. secondary" courses do not mean junior-college-level courses alone, 2-year programs which provide "an organized occupational curriculum" and usually lead to an associate's degree or the equivalent. Rather, any postsecondary education provided in any way is included. Second, these very limited VEA funds are for all occupational and technical programs which are supported, not for health-related programs alone. Thus, only a small part of available Federal funds goes to healthrelated programs in any case. Third, a large number of "adult" students are also trained with assistance of VEA funds. These are, for the most part, adults taking a few courses in the evening. Some of them take courses in junior colleges or as part of an organized curriculum, but many do not.
Therefore, the conclusion still stands that very little VEA money goes to junior colleges or to other postsecondary programs of a comparable kind, and even less goes to support health-related programs.
It would be a relatively simple matter to amend this bill to include associatedegree or junior-college-level students, and it would not be very expensive a few million dollars in a multibillion-dollar budget.
It was suggested at the committee hearing that if this is a "vocational education" matter it is not within the jurisdiction of this committee. However, if the committee is so deeply involved in the support of health programs at the graduate, undergraduate, and nursing levels, it is unquestionable "in education" in this field. It would therefore seem very appropriate for the committee to consider this as a matter of health education, and therefore suitable for committee action. I have prepared this brief statement in answer to your request for more information. Please let me know if I can be of further assistance.
Mr. Robert Kinsinger will appear before the committee on March 31 on behalf of the American Association of Junior Colleges, and will be able to answer your questions in more detail.
JOHN P. MALLAN, Director of Governmental Relations.
The CHAIRMAN. Thank you, Mr. Kinsinger.
Mr. Moss. Yes, Mr. Chairman. First, let me say that I think you have covered quite well the one problem of expanding this program for training of medical support personnel but do you envision that as the only role of the junior college?
Mr. KINSINGER. Not at all. As you indicated in your earlier discussion with the witnesses, the importance of the junior college as the first 2 years of a 4-year program shall be noted. I also felt that this should be emphasized. Junior colleges have a multiplicity of roles, one of the major ones is the occupationally oriented program of the type that I have been discussing here, but equally important is their role in providing the first 2 college parallel years moving on into baccalaureate programs.
Mr. Moss. In many instances the course available at junior colleges would exactly parallel similar courses at such universities or other colleges in lower division work?
Mr. KINSINGER. Yes, sir; they do. In fact that is required of them in order to insure that their students will be able to move on because many of them come to the junior college merely as a less expensive way to prepare themselves during the first 2 years.
Mr. Moss. There seems to be a little inequity in the proposal then that would give to one institution because it grants a baccalaureate degree aid in maintaining a course and deny it to another? Mr. KINSINGER. Yes. I would subscribe to that position completely.
Mr. Moss. So we would have to amend, on page 15 of the bill also under section 795, definitions?
Mr. KINSINGER. Yes. You could, by inserting one phrase say, "which provides primarily or exclusively programs of education leading to" and insert "an associate degree or equivalent" and then go on "a baccalaureate or equivalent.
It could be done by inserting "associate degree” in there.
The CHAIRMAN. Mr. Younger.
Mr. YOUNGER. Thank you, Mr. Chairman. I have no question. I do want to compliment the witness on a very fine plea for the junior colleges which we are certainly interested in so far as California is concerned.
The CHAIRMAN. Mr. Pickle.
Mr. PICKLE. Thank you, Mr. Chairman.
I am wondering if Mr. Kinsinger could give me any indication of the cost involved if this program was enlarged to include junior colleges for these traineeships?
Mr. KINSINGER. No, I cannot. I would not attempt it and I will have to equivocate on that question. I have not attempted to make any estimate on the cost that would be involved. My proposal, on the last page of my prepared statement, was that we provide for traineeships for baccalaureate level people who in turn are going to become teachers of junior and community colleges.
At this time, I have just been involved in setting up two educational programs for the preparation of teachers for community colleges at the State University of New York at Buffalo and City University of New York. In both cases support for trainees is a problem. We need just the kind of traineeship that this bill would provide for to attract to these educational programs individuals who are willing to convert their vocation from a paramedical practitioner to a teacher of health techniques in a community college.
We somehow have to provide finances for them while they are going through this process of transition. To answer your question, specifically, I have not made any projection of the increased cost that this would involve.
Mr. PICKLE. Is it your idea to take whatever funds have been specified or will be specified in the bill and spread them equally to junior colleges as well or would you envision an increased amount?
Mr. KINSINGER. I am sure it would require an increased amount of money.
Mr. PICKLE. Then how much would it require?
Mr. KINSINGER. That, I am not prepared to answer. Had I anticipated this question I might have been able to make some estimates of it, but I simply will have to beg off on the question.
Mr. PICKLE. Would you think it would be a sizable amount in view of the fact that there are so many junior colleges all over the country?
Mr. KINSINGER. If you were going to restrict this just to the preparation of instructors for the community college I would not see this as a sizable amount. If you were to add, as Mr. Moss suggested, putting in under definition "an associate degree" it would then open up the whole field and it could be a very sizable amount of money.
Mr. PICKLE. I can understand, Mr. Kinsinger, your desire to offer this training on the junior college level and you have raised some good points. We are limited though on how far we can go at this time. This is, of course, part of the overall problem.
Mr. KINSINGER. That is why I restricted myself-my specific suggestion to merely changing the wording on page 14 which would permit us to prepare instructors for community colleges.
Mr. PICKLE. Have you or your associates talked with the Surgeon General about this?
Mr. KINSINGER. Yes, sir.
Mr. PICKLE. What did he tell you?
Mr. KINSINGER. I had better not put words in his mouth. As of this morning I talked to one of the members of the staff and indicated the suggestion that I was going to make that the wording be changed on page 14. I talked to Dr. Silver of Dr. Phillip Lee's staff. He felt that this was their intention all along and that this change would specifically make it possible to do this.
Mr. PICKLE. Thank you.
Mr. Moss. Mr. Chairman, will the gentleman yield?
Mr. PICKLE. Yes, I will yield to the gentleman from California. Mr. Moss. Mr. Chairman, I would like to request at this point that the Department prepare some figures dealing with any additional cost covered by the amendment proposed in the statement of the witness as well as an amendment which I will propose on page 15 to expand the number of eligible applicants for this program. I thank the gentleman for yielding.
The CHAIRMAN. The committee will ask for that. (The information requested follows:)
COST ESTIMATES FOR PROPOSED MOSS AMENDMENTS TO H.R. 13196
I. To add the words "health services technicians or" between "teach" and "in", page 14, line 13 (i.e., specifically mentioning teachers of health services technicians in the provisions relating to traineeships for advanced training).
Although the purposes of the traineeship section as originally proposed included the training of teachers, $1 million has been added to the original cost estimates to reflect increased emphasis on this expanded aspect of the traineeship program. II. To add the words "associate degree" to page 15, line 18. Attachment A shows estimates of
The assumptions on which the estimates were made were as follows:
1. Only associate degree programs were included. (It is assumed that the junior college practical nurse and other less than degree programs would continue to be funded by vocational education.)
2. Associate degree nursing programs are not included.
3. In calculating the number of students in allied health curriculums, as a basis for estimating the cost of basic improvement grants, only the final year enrollment was included. (The first year is usually general education.)
4. Rate of program growth was estimated to be about the same as all vocational education programs from 1950 to 1965, and as the growth of AA programs in nursing from 1962 to 1966.
5. The following figures were used for number of schools, programs, and secondyear students:
New obligation authority
(a) Construction grants..
6. Construction was estimated as an average grant of $250,000 per institution— 8 schools in 1967, 20 in 1968, and 28 in 1969.
Junior and community colleges...
7. Traineeship grants were estimated as in I above.
8. Developmental grants were estimated at $0.5 million, $1.5 million, and $2 million. It seems reasonable to provide the same amount of funds for developmental grants for junior colleges as previously estimated for developmental grants for baccalaureate and graduate level programs.
Estimated new obligation authority required for fiscal years 1967-69 under amendment making junior college associate degree programs eligible for participation under Allied Health Professions Personal Training Act of 1966 (H.R. 13196)
[In millions of dollars]
Health occupations enrollments under vocational education programs, 1965 (preliminary figures) Preparatory:
High school and short term 1-2 year post high school...
HEALTH OCCUPATIONS TRAINING PROGRAMS IN JUNIOR COLLEGES UNDER VOCATIONAL EDUCATION AUTHORITY
Under the Smith-Hughes Act, and until the Vocational Education Act of 1963, vocational education funds were available only for training at less-than-college grade. It was not until 1965 that there was an official ruling on funding health occupations at the junior college level.
In 1965, of a total of $5.6 million vocational education funds expended for health programs, $900,000 was expended on junior college programs, with an enrollment of about 9,000: 2,000 in associate degree programs and 7,000 in practical nurse programs and other less-than-degree programs.
The following preliminary figures show the relation of junior colleges to the total health occupations training effort of the vocational education program in 1965:
12,000 44, 000
9, 000 35, 000