Describe for us what you mean by the allied health profession? Secretary GARDNER. I think I might ask the Surgeon General to respond.

Dr. STEWART. The allied health professionals are a large group of technologists who do the technical support work for the physician, dentist or nurse. There are about 30 occupational groups we are talking about. I have a list of them. I might give you some examples. The CHAIRMAN. If you would, please.

Dr. STEWART. A bloodbank technologist. A cytotechnologist, dental hygienist, dietician, hospital administrator, medical illustrator, medical record librarian, medical technologist. These are the types of allied professionals we are talking about. It is really the type of individual who has evolved because the technology of medicine has advanced.

Somebody has to do the specialized techniques that have been developed in order to carry out laboratory work or X-ray procedures. If you have had X-rays taken in the doctor's office it is usually the X-ray technician who takes your picture. They are experts on how to position the patient, what dose to use in taking the picture.

The physician then is the interpreter of the X-ray, what it shows. It adds that information which goes into the diagnosis. In the laboratory the physician does not do all the blood tests and the other tests. These are done by technologists who are skilled in doing the various tests. With the advances in science and medicine in the last 25 years the number of technologists is increasing yearly.

The CHAIRMAN. These are allied health professionals. Would you supply a complete list for the record?

Dr. STEWART. Yes, I can.

May I amplify one bit? The word technologist has now come to stand for the person who has had somewhat more advanced training than the technician. A technician is a person who generally has 1 or 2 years of training who does the bulk of the work in the technical area, that is a sort of mass work, llke the blood counts, this sort of thing. The technologists are generally trained at the baccalaureate and masters levels; they are the ones who do the more complicated technical work, and who supervise the technicians. They also teach the technicians. This is what has evolved.

We will be glad to supply this for

you.

The term "allied health professions" has come to be used to cover a variety of technically trained people. They sometimes form themselves into professional groups and others have stayed as a technical group. These are words really.

The CHAIRMAN. All right.

Secretary GARDNER. Mr. Chairman, we will provide a list for the record.

The CHAIRMAN. I wish you would because these two words "professional" and "technologist" could mean exactly the same. (The information requested follows:)

LIST OF ALLIED HEALTH PROFESSIONS

With the rapid pace of new medical discoveries and technological developments, the roles, potentialities, and names of the allied health professions are being added to continually. New specialties emerge in response to new developments. The following list of 30-plus professions is grouped into four categories. The first three are not fixed or rigid. The fourth includes those professions now covered under HPEA or NTA.

1. Professions for which preparation is now offered in one or more centers for the training of the allied health professions:

2. There are some allied health professions which, at present, are not administered or taught by health or medical departments of the colleges or universities. Though medical in orientation, the basic preparation for these professions is such that other departments offer the major portion of training. The courses which are medical or biological in nature could be offered through the school of allied health professions:

Biostatistics.

Bioengineering

Computer programing..
Health administrator_.
Health economist___.
Health educator__.
Manual arts therapist..

Music therapist..

Recreation therapists_

College degree awarded by the math depart

ment.

Do.

Do.

Graduate work in schools of public health.

Do.
Do.

College degree with major in industrial arts, agriculture, or related field.

Baccalaureate degree in music.

Baccalaureate degree in recreation or in physical education with courses in art, music, and drama.

3. Other professions for which all or part of the training might be provided in schools of allied health professions:

Medical social worker

Psychometrist

Radiation engineer
Radiobiologist

4. Professions covered under Health Professions Education Act or Nurse Training Act.

Dr. STEWART. Allied health professions covers the groups I was calling technologists. The ones requiring the baccalaureate degree or master's degree. This is distinguished from the technicians who are trained mainly in the vocational schools or in the community colleges throughout the country, at a 1- or 2-year level.

This is the distinguishing mark I think between the two groups. Secretary GARDNER. I think that most professionals would describe this level as subprofessional actually. I would.

The CHAIRMAN. We will accept your description.

I seem to have read somewhere that some one of our professionals said that we succumb to disease, we do not wear out. Is this a sensible statement, that we succumb to disease, we do not were out?

Dr. STEWART. Mr. Chairman, I missed the first part of your question. The CHAIRMAN. We succumb to disease, we do not wear out. Would that be correct?

Dr. STEWART. Well, I think there is an aging process that goes on, whether one wants to describe it as wearing out or not. There are changes in one's physiology and psychology which occur with age which cannot be ascribed to a particular disease.

Now when these aging processes manifest themselves in something which is visible or can be measured or something like that, then we usually label it a "disease." But there are two different processes. One, the disease may have its own scientific-its own specific cause, whereas the aging process is part of human development-well, the other end of human development in a sense. The two are interrelated but they are two different things.

The CHAIRMAN. I believe this statement came out of a study of the elderly and aging process and I thought I would mention it. It says, again, that if we make the greatest use of our medical knowledge today that we can cut the death rate about in half.

Mr. Friedel.

Mr. FRIEDEL. I was very much impressed with your statement, Mr. Secretary.

Secretary GARDNER. Thank you.

Mr. FRIEDEL. I would like to know more about the student loans. Are they for families that are poor who would not be able to send their children on for further education or would family background be considered?

Secretary GARDNER. You are speaking now of loans, not the traineeships?

Mr. FRIEDEL. Student loans.

Secretary GARDNER. I am going to ask Mr. Kelly to comment on that because he has given special attention to it.

Mr. KELLY. The law requires that the institution making the loan determine that the student requires the loan in order to enter or continue his education. The institution has only limited funds available to it. They are in relatively high demand, therefore it has to determine a method for that institution to allocate its funds to its most needy students. The law does not prescribe a specific requirement as to what the income limit will be. It merely requires that the institution determine that the student needs the loan in order to pursue his education.

Mr. FRIEDEL. I have had inquiries from parents where they applied for a student loan and they were turned down, some that could not further their education unless they had a loan but the school said they were out of funds.

I am a little perplexed here. As I understand it now any student who wishes to further his education has to apply to the school for a loan, and the school itself may in turn make the loan if it has the funds available. Here you mention private loans. That is where I am a little confused.

Mr. KELLY. Under the present arrangement, the only loans that the Federal Government is participating in are direct loans which the Federal Government makes to the contribution of the educational institution. The educational institution puts up one-ninth of the funds and they in turn make a loan to the students.

Last year the Congress enacted the Higher Education Act of 1965 and introduced a new concept which augmented and extended these loan programs which made it possible for States, for private institutions, or direct arrangements between the Federal Government and financial institutions to make loans through private financial institutions to students, these loans being both insured by the Federal Government and the interest being subsidized by the Federal Government.

This new program of insured loans and subsidized loans which was authorized last year is just now getting underway.

No student has yet gotten a loan. The regulations are now in the process of being cleared and discussed with States, the financial institutions and the various loan associations. Twenty States are now ready to enter into agreements, to participate in this private loan program. So that students who have heretofore been turned down because there were inadequate loan funds available and because the family was of a higher income than those who were getting the loans will be able to participate in these insured loans.

Mr. FRIEDEL. Thank you. That is all.

The CHAIRMAN. Mr. Younger.

Mr. YOUNGER. Thank you, Mr. Chairman.

Mr. Secretary, on this provision that you have about the forgiveness of their loans to doctors in poor rural areas, who is going to determine that means test?

Who is going to determine what is a poor rural area?

The means test of what constitutes a poor rural area, who is going to determine that?

Secretary GARDNER. Dr. Lee will answer that.

Dr. LEE. I think that will be determined primarily at the State level. The State health officer would be one of the people involved in the decision.

Dr. STEWART. The bill provides that the Secretary determines them on the recommendation of the State health authorities.

Mr. YOUNGER. You have provided here 10 percent a year which goes up to a hundred-percent forgiveness. Who is going to determine that, whether you are going to give a 50-percent forgiveness or a hundred percent?

Secretary GARDNER. Under this bill a total of a hundred-percent forgiveness will be possible if the doctor continues to practice for an appropriate length of time in a designated area. I believe it is now 50 percent; is it not?

Dr. STEWART. Yes. At the present time it is 10 percent per year for 5 years which makes it 50 percent. The proposed bill will increase that to 15 percent per year up to 100 percent; at that rate it would take about 6 or 7 years to forgive the whole loan.

Mr. YOUNGER. Now one thing that is rather disturbing to me, and remains unanswered, and you make a very good case of the tremendous shortage of facilities, teachers, technicians, doctors, nurses, every classification.

You make a good case for that big shortage in this country. Yet the bill that we had recently on the training for Foreign Service, which includes training about 800 or a thousand a year, would provide for tuition, per diem expenses, and everything if you want to go into Foreign Service.

There is no requirement for the trainee going into Foreign Service. How are you going to put that load into the schools and into the training programs and at the same time try to satisfy this tremendous shortage that is local?

Where are you going to get the teachers for both of those programs, one right on top of the other? And one of them where you subsidize their entire education complete with per diem and everything else and the other you are not?

Secretary GARDNER. I would like to ask the Surgeon General to comment but first I would like to make one or two basic points. First, the international program does not involve as many physicians as you indicated.

It would be closer to 400. The second thing is

Mr. YOUNGER. Just a minute. As I recall the testimony-I am not talking about physicians, I am talking about the total personnelas I recall the figure was given of between 800 and 1,000 at the time of the testimony.

Dr. LEE. Mr. Younger, the international health programs will include a number of other types of health workers-sanitarians, public health workers, and a variety of other types. That is right. Mr. YOUNGER. But they are all to be trained under the program? Dr. STEWART. Mr. Younger, under the international health bill the training was beyond the M.D. degree. They would already be doctors. Under that program they would be trained in international health work. That bill was dealing with professionals: doctors, dentists, nurses. This bill here is talking about the allied health professions which is a different group of people.

Mr. YOUNGER. Yes, but you have to have facilities to train them. You have to have teachers to train them.

Dr. STEWART. The Health Professions Educational Assistance Act and the amendments of 1965 are building medical schools and dental schools, and the Nurse Training Act is building nursing schools. We are expanding our capacity for doctors, dentists and nurses. We do not have the capability of training a person in international health work after he has become a doctor, dentist, or nurse.

Mr. YOUNGER. You do not have the facilities?

We

Dr. STEWART. No. We do not have the training programs. do not have the means to send the people to those training programs. That is what the international health bill is for.

Mr. YOUNGER. But you would have to provide that, normally it would be in the medical schools would it not?

Dr. STEWART. It may be in medical schools. It could be in schools of public health.

Mr. YOUNGER. Schools of public health or whatever, you have only so many facilities for training. It would not make any difference whether the doctor was already a doctor, he has got to be trained, he has to have a facility to be trained in.

Dr. STEWART. Yes, but I think you are thinking of a medical school as a facility. A university medical center now may be a whole complex of facilities.

Mr. YOUNGER. That is right.

Dr. STEWART. It may be a variety of schools. It may include a nursing school, dental school, and health allied professions school.

Mr. YOUNGER. True. In every one you are short today, in every training facility. I don't care what it is, whether it is a podiatrist or who it is, you are short on training and you are short on personnel. Dr. STEWART. That is correct.

Secretary GARDNER. May I comment, Mr. Younger?

Mr. YOUNGER. Yes.