The shortage of personnel in this field has been documented in such studies as the "Report of the President's Commission on Heart Disease, Cancer, and Stroke, December 1964"; and the "Manpower Report of the New York State Governor's Council on Rehabilitation, December 1965." The latter indicates the following number of unfilled positions in 1965: Nationally... New York State.. Departments supported by New York State (percent) 15, 600 5, 600 53 38 Against this background, compare the figures showing the present supply of occupational therapists. The American Occupational Therapy Association shows the number of registered occupational therapists to be 7,390, of whom approximately 3,500 are actively practicing. In the fall of 1965, 2,787 students were enrolled in the 32 professional schools in this country, with an anticipated number of 438 graduates to take the national registration examination in 1966. Reasons for the personnel shortages are complex and have to do with (1) the expansion of needs and demands for treatment; (2) difficulties in expanding present educational programs because of limited physical plants; (3) shortage of instructional personnel; (4) the cost of education; and (5) the recruitment of more young people into this service field. Our need for your assistance is urgent and immediate if we in occupational therapy are to meet the present requirements for our services, and if we are to develop the necessary services for patients under the Medicare Act, as well as the other programs of Federal and State concern. The present physical facilities for education must be expanded and new ones built. More opportunities are needed for seasoned personnel to better prepare themselves for educational and supervisory roles. New and imaginative curriculum planning must be done to use to best advantage the available educational resources-human, visual, and mechanical. Programs of recruitment and student aid must be continued." In order to correct some of these deficits we entreat your consideration of this request for the inclusion of "occupational therapy" by name in H.R. 13196, the Allied Health Professions Personnel Training Act of 1966. Miss SCHNEBLY. Briefly, my purpose in appearing before you today is to respectfully request that the profession of occupational therapy be specifically named within the proposed H.R. 13196. The written statement does present information supporting the need for more occupational therapists in the health field and to meet this need we recognize that facilities, recruitment, and education of personnel for faculty are essential. My testimony could strongly parallel that which Miss Blair and others have already given. I am in accord particularly with Miss Blair's comments. First, I would like to say that we do strongly support the intent of the bill to create more facilities. This is an unmet need of occupational therapy. Many of the existing programs lack adequate space for the present classes and are totally unable to increase their student enrollment. One school is limited to 36 in the junior and senior classes, another is limited to a total of 50 students in the entire student body, just because of inadequate space. Second, I would like to bring to the attention of the committee that we have received and are receiving considerable support for traineeship grants from some of the Government agencies, notably the Vocational Rehabilitation Administration. This support has continued for more than 10 years. It has been brought to my attention that in the 1967 budget of the VRA, $1,019,000 has been identified for occupational therapy to provide 458 traineeships and 26 teaching grants. These traineeships are not only for the occupational therapy practitioner but also for those going on into teaching and research. The graduate traineeships enable the field to develop a small cadre of leaders. However, this amount is not sufficient for the need of the profession at this time. I would like to offer support to the statement that Secretary Gardner made several days ago in urging that the programs developed in this bill be closely coordinated with ones already in existence such as the programs in VRA. This coordination would help to further the health-related professions by the strength gained through intergated, correlated financial support. I would like to bring one item particularly to the attention of the committee in section 15(c) of the bill. This seems to have implications which in interpretation may prevent the eligibility of some of our occupational therapy programs to receive funds. As I understand it, this section states that the allied health educational programs must be within settings that have teaching hospitals as part of the university or closely affiliated with them. It is requested that the intent of this section be broadened to include all of our occupational therapy schools because of the clinical affiliation portion of the educational program. All of the schools have clinical affiliations in a variety of teaching hospitals over the country. These may not be necessarily a part of the specific university program but are selected and used by the occupational therapists in the program of teaching. We request that all programs using accredited hospitals for clinical affiliations be considered eligible for funds. I thank you very much for extending the time to me to speak before the committee. I will try to answer any questions you may have. The CHAIRMAN. I want to thank you very kindly, Miss Schnebly, for coming to the committee and giving us your views. I would say to you that I am advised by our counsel that your group is included in the bill. I wanted you to know that. Mr. Murphy. Mr. MURPHY. I would like to congratulate Miss Schnebly for her statement. We certainly appreciate your appearance before the committee. Miss SCHNEBLY. Thank you, sir. The CHAIRMAN. Mr. Younger. Mr. YOUNGER. No questions, thank you. The CHAIRMAN. Again I want to thank you for coming and giving us the benefit of your views. I am assured by our counsel that your group is included in this bill. Of course, your statement will be in the record and the statement will be considered when we consider the bill in executive session. Miss SCHNEBLY. Thank you. The CHAIRMAN. I would like to include in the record at this point a statement by Eugene McCrary, president of the American Optometry Association. 62-707-66- -9 (The statement referred to follows:) STATEMENT BY V. EUGENE MCCRARY, O.D., PRESIDENT, AMERICAN Mr. Chairman and members of the committee, I am pleased to have this opportunity to express to you the views of the American Optometric Association on H.R. 13196, the Allied Health Professions Personnel Training Act of 1966, and to tell you of our concern that the Department of Health, Education, and Welfare has again overlooked our profession in the drafting of health manpower legislation. It is true that optometrists utilize a smaller number of assistants than the medical or dental professions, but not in proportion to the number of members in the profession of optometry. There are some 17,000 practicing optometrists who today employ some 35,000 optometric assistants. This committee, in recognition of the need to double the number of optometrists, included optometric schools and colleges and students in three separate acts for health professions educational assistance. If we achieve our goal of doubling the number of members of the profession, we will need at least 70,000 optometric assistants. If we do not achieve our goal we will need even more than that number of assistants so that we will have more arms and legs to serve the visual needs of our American population. In addition to the growth of the population, we are experiencing a growth in professional knowledge. With this growth in knowledge we find the need to spend more time with the patient and the need for more assistants so that our professional time is used as efficiently and economically as possible. The bill presently before you requires that schools to be eligible for traineeships to help prepare teachers, administrators, supervisors and specialists in the various allied health professions must include or be affiliated with a medical or dental school and a hospital. This provision effectively bars the training of optometric assistants under the act. We respectfully recommend that optometric schools be included as eligible under the appropriate provisions of the bill. We were further concerned when the Secretary of the Department of Health, Education, and Welfare in his testimony said, "Specially trained bioengineering technologists will make possible both use and development of radically new diagnostic and therapeutic equipment," and then went on to modify this statement by saying, "Technologists to work with physicians to extend these services will require specifically designed training." We believe the Secretary must be completely unaware of the development of the electronic tonometer, a highly developed modern instrument to detect glaucoma, by optometry at an optometric school. To restrict such technologists only to service under physicians is to bar possible progress by other health professions such as our own. We hope this committee will, in its report on the bill, bring to the attention of the administration the need to utilize all of the Nation's qualified health resources, including the optometrists and their assistants, in programs of the Department. The Department of Defense is now drafting optometrists to take care of its critical shortage in the field of vision care. Many of our young O.D.'s are being called from rural areas with populations of 50,000 or more, and no other optometric care available. The schools of optometry, the American Optometric Association, and the States themselves, have persuaded and cajoled these young men to practice in these rural areas which have been short of health manpower. We find by comparison that physicians have more inducements to practice in these areas than do optometrists. Accordingly, we do not understand why the administration is offering more forgiveness of loan incentives to physicians than they are to the other health professions. The determination of a critically short area in health manpower is left to the decision of the States. To our knowledge, none of them has reported any experience in providing forgiveness of loans that would indicate that more incentive is needed to obtain a physician for one of the shortage areas than is needed to obtain an optometrist or a dentist. We ask that the same incentives be applied across the board to all the health professions which are authorized under previously enacted legislation to receive forgiveness of loans. The American Optometric Association is happy with the provisions for the conversion of health professions student loans from direct Federal financing to a guaranteed and subsidized basis. We believe, however, that it would be wise to move slowly on these student loan conversion provisions until adequate private sources for loans have been found which will agree to the terms of these provisions. The profession of optometry will always be grateful to this committee for its support of the profession and its concern for the visual welfare of our Nation. We ask only that it give the most serious consideration to the proposed changes in H.R. 13196 which we are bringing to your attention. Thank you for the opportunity to present this statement. I will be pleased to answer any questions or to provide any additional information which you might like for the record of this hearing. The CHAIRMAN. I would also like to include in the record a statement by Ruth M. Latimer, director of the physical therapy educational program, University of Maryland. (The statement referred to follows:) STATEMENT OF RUTH M. LATIMER, DIRECTOR, PHYSICAL THERAPY EDUCATIONAL PROGRAM, UNIVERSITY OF MARYLAND I speak in support of H.R. 13196, Allied Health Professions Personnel Training Act of 1966, and request your consideration of amendments to specify the allied health professions with particular consideration to the profession of physical therapy and to the educational programs accredited by a recognized body approved by the Commissioner of Education. I am sure you are aware of the need for health personnel in all areas and note certain factors that make physical therapy personnel in particular demand; namely, the increasing longevity of man and subsequently chronic diseases, the large number of persons injured by accidents but left with a disability, other Federal legislation pertaining to social security and vocational rehabilitation, and programs for the mentally retarded and heart disease, cancer, and stroke. In the March 7, 1966, edition of U.S. News and World Report, Dr. Harvey Scudder, Director of the Health Manpower Resources Unit of the Public Health Service states that physical therapists are chief among the lacking health personnel. There are presently 12,000 with a need for 20,000 and by 1970, 40,000. The objectives of physical therapy education are to increase the quality and quantity of personnel to cope with the demands. These objectives would be facilitated with Federal assistance to promote expansion and improvement of the existing 42 educational programs, to encourage additional new programs of which there are presently 6 in stages of development, and to offer loans and scholarships to worthy students. The CHAIRMAN. This concludes our hearing on H.R. 13196 and the record will be kept open for 5 days for further statements which are to be included in the record. The committee is adjourned subject to the call of the chair. (The following material was submitted for the record:) STATEMENT OF THE AMERICAN PUBLIC HEALTH ASSOCIATION The 16,000-member American Public Health Association, which has an additional 25,000 members in State affiliated societies, wholeheartedly supports the concept and purpose of H.R. 13196. Although long overdue, this legislation should, indeed-by leading toward a comprehensive, nationwide program for training personnel in the allied health professions-fill a vital need both in the attraction of youthful talent to the field of health and in the provision of opportunity to these youth. This legislation is vital to the full future staffing of the Nation's hospitals, medical and dental laboratories, and other health facilities. And without it, full utilization of the time, talents, and energies of the other members of the modern health team-our physicians and nurses particularlywill not be realized. We must have this bill to protect our investment in the legislation this same Congress enacted last year and in other legislation passed somewhat earlier, specifically the Health Professions Educational Assistance Act, the Nurse Training Act, and the Vocational Education Act. Beyond the field of health, each community and each congressional district in the Nation should offer to its youthful citizens the opportunities that would be provided in this legislation-opportunities to be trained near their own homes in important professions and technologies within what has emerged as an American "growth industry," the field of health. Modern medical advance had led to a team approach to each patient's health needs. Each member of that team is vital. That is why we need-as listed by President Johnson in his recent health message-medical technologists, biomedical engineers, dental hygienists, and other college-trained healthworkers. The American Public Health Association, again supporting the concept of this legislation, would modify that concept in several ways-in hopes of abetting the national purpose. We know Congress is in sympathy with that national purpose, and we hope this committee and the Congress will approve these modifications: (1) There is no foreseeable limit as to the kinds and types of health workers we will eventually need. But there is a clear and obvious need, right now, for the following: Medical technologists, X-ray technologists, anesthesiology technologists, dental hygienists, rehabilitation counselors, speech pathologists and audiologists, physical therapists, occupational therapists, medical record librarians (particularly for the Nation's hospitals). Although we do not think the legislation needs redrafting for this purpose, the association feels this committee should lead the House of Representatives toward an expression of congressional intent that these workers, at least, should be covered through their training by this legislation. In addition, because the needs of even the immediate future cannot be forecast with certainty, the Department of HEW and the Public Health Service should be allowed to add to this minimal listing. (2) A second modification to the concept of this legislation, it is felt by our association, should be the provision of specific and generous sums of money to do the job. And in the subsequent years of the appropriation process, there should be no backing off from this original committment to a fast-moving, wide-spreading program. This program should be allotted, both in the original authorization and subsequent appropriations, amounts adequate to the task, remembering that it is an investment both in that dear commodity, our Nation's health, and in the career patterns open to the youth of this country. (3) A third modification would expand the legislation's concept as a career alternative to our youth. The American Public Health Association suggests addition of a program of project grants to junior colleges. Junior colleges should be allowed to initiate and carry forward a variety of programs to attract and train health professionals and technologists of all kinds, particularly a number of talented youths who, for various personal and economic reasons, had not contemplated 4 years of education beyond high school. But they must have the well-trained teachers to guard against an inferior product. Project grants to junior colleges would, we believe, both (1) enhance the legislation's major purpose of increasing the health awareness and capabilities of every community and (2) insure that at least in junior colleges, a health career opportunity is brought to the attention of, and made available to, our Nation's youth at a time when these youngsters are making the most crucial decisions of their future. The health of our Nation demands it. The youth of our junior colleges, as well of our universities and 4-year colleges, rightfully deserve it. We would like these modifications to be kept in mind during our comments on each specific provision of the proposed legislation. H.R. 13196 would provide bricks and mortar money, with up to 66% Federal funding and expansion requirements that commit participating institutions, in effect, to spend more themselves than the woefully inadequate sums they have had available in the past. This is a tried and tested pattern of Federal funding, one that has worked well to revive or create State, local, and institutional interest. Each Member of the House of Representatives should look with favor-as do the members of our association who have seen this Nation's pockets of inadequate health care on two important criteria for the Surgeon General's approval of facilities funding: (a) Each proposal is to be evaluated in the light of its effects in securing equitable geographic distribution of training facilities, and (b) Each proposal must mesh with State and local health planning, the latter hopefully to be stimulated and facilitated by another legislative proposal before this committee, H.R. 13197. A caution concerning equitable geographic distribution is in order. This provision should not under any circumstances be allowed to hold back a desirable improvement, even in areas of the richest medical background. These areas of comparative medical plenty are leadership areas, and leadership toward excellence should be encouraged, particularly when the cost can be measured in terms of relatively few dollars. This construction program must move quickly. None of these teachers, supervisors or health workers we refer to can be trained on sidewalks. Facilities and equipment must be available. Congress should so instruct the executive branch, both the Public Health Service and the Bureau of the Budget. Another major section of the bill would provide basic and special improvement grants to efforts in the training of allied health professionals. Again, this pattern |