wear Thas the President's request was $500 million less than the AAMC's estimed firement Where is the sense of the impending massive crisis? Touring a Presidential veto, the House of Representatives defeated an amendto the proposed Labor-HEW bill which would have come closer to the a est.rate by appropriating almost $2 billion. This $400 million in de which the House voted down, is equivalent to the cost of only 5 days Iiwhina war Why can't we translate our expressed concern over the ss in health care into the necessary spending priorities?

is it in the area of health care, we calculate our costs in dollar terms, le real cost of our neglect will be paid in human terms? We can begin tur se costs in the St. Louis area. St. Louis University School of Dentistry Pasted its last class in June of this year. Missouri Baptist Hospital's School

gfaces the prospect of closing, after 73 years, because it will not rea $4 210 grant for construction. This grant, for which we have been L was part of the added $400 million which the House failed to approve. is encouraging to learn, however, to learn that St. Louis University's Medical will receive a $2.5 million NIH grant to update its facilities.

in an her side of the meager health care coin, the dean of St. Louis Testy & Medical School has noted that the tuition raises necessitated by kin federal funds, coupled with the decreased appropriations for stuwars, are "pricing the poor boys out." St. Louis University has been at2 to feed both numerical and distribution manpower needs by increasing Duent and offering opportunities to minority students. health care manpower crisis is only one illustration of the frequently. swed for reordered priorities. Funds for domestic programs-education, hospital construction - have been vetoed as inflationary. But as Senator snited inflation in health costs is due to a lack of money, rather than *1 **s of money. Without increased funds for health manpower, the inflation heath system, due to inadequate manpower, will persist.

The conclusion, then, is that as long as federal money continues to be spent the big that crises abroad are worth spending 73 times the amount spent *ses at home, any new creative programs for dealing with health needs can Le to a dead end

if these finds were available to us, what are some programs which might We right follow the AMA's suggestion that greater public outlays be utilized a train medical practitioners, and a smaller percentage be allocated to pure

**ives might be offered to encourage more medical students to enter al practice, supplement.ng the specialists and enhancing the availability family practitioner to serve a larger number of patients, especially in

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grans like the Medex experiment at the University of Washington, where el trained by the armed services receive further development in their merted skills could be expanded.

Aed Health Professions Personnel Training Act, passed by Congress y, would provide assistance for construction of facilities to train allied neofessionals, as well as grants and traineeships to develop better methods a bing health technologists. These efforts must be implemented so that emapo fees, nials will be enabled to relieve doctors of some of the more routine ** of patient care.

- ral support were available, universities could establish demonstrational attached to their medical schools, which would train and place allied workers--such as pediatric nurse practitioners, physicians' assistants, hygienists. These paraprofessionals along with doctors would consti» Lea "h, tennis, serving a three fold purpose their own education, experiwith new divisions of medical labor, and community service- helping to re a better distribution of health care. Such a plan might be incorporated AMA President Dr Walter Bornemeier's suggestion that the government ghetto clinics to be operated by medical societies, medical schools, and te doctors

I shall introduce legislation to help resolve the distribution problem when the #I se reconvenes on September 9. This bill would encourage physicians, dentists, Tetrists and other medical personnel to practice in medically deprived

The Federal government would repay the loans a student ineurs while a medal school, if he agrees to practice for three years in a location where

a critical health manpower shortage exists. This act would both allow graduating doctors to begin their practice debt-free, and give them the incentive to go into communities which desperately need their services.

These innovations will require a commitment of both dollars and energiesand will constitute only the first steps toward guaranteeing that the right of every citizen to adequate health care becomes more than a cliche.

Besides these specific measures geared toward meeting immediate manpower shortages, a comprehensive national health plan to deal with the problems of recruitment, training, and distribution could assure that medicine in America would move beyond a crisis-response situation. AAMC Chairman Dr. William G. Anlyan has called for developing a strategy program by "working the domino theory backwards." Dr. Anlyan suggests that medical schools and practicing professionals develop a blueprint of highly visible health goals with a specific target date, for example 1985. Then health experts could determine what resources would be needed in 1980, 1975, and backward to next year. After medical experts developed the blueprint, government would respond and react. We will have an opportunity to begin such an examination next year when the 1968 Health Manpower Act comes up for Congressional renewal. I am confident that these hearings and the distinguished St. Louisans who will testify will be helpful in that review.

If the government is to respond to health needs-to solve the problem of manpower in all its manifestations-we must start with the tools at hand. If the prognosis for our national health is to improve, as a nation we must be prepared to rearrange our budget and to put the medical bill at the top.

Senator EAGLETON. We will now hear from four witnesses simultaneously, as it were, all in various capacities affiliated with St. Louis University, our host today for these hearings.

Mr. Ben F. Jackson, the chairman of the Medical Center Committee, St. Louis University Board of Trustees.

The Reverend Paul C. Reinert, president of St. Louis University. The Reverend E. J. Drummond, vice-president for the Medical Center of St. Louis University; and

Dr. Robert Felix, the dean of the School of Medicine of St. Louis University.

Would Mr. Jackson, Father Reinert, Father Drummond, and Dr. Felix join us.

May I say, gentlemen, each of you has a prepared statement, and I want to point out for the record, that all prepared statements will be printed in the record in full.

Mr. Jackson, Father Reinert, Father Drummond, and Dr. Felix, you are each at liberty to read your prepared statement in its entirely, or summarize it, or elaborate on it, as you see fit.

STATEMENT OF BEN F. JACKSON, CHAIRMAN, MEDICAL CENTER COMMITTEE, ST. LOUIS UNIVERSITY BOARD OF TRUSTEES

Mr. JACKSON. Thank you, Mr. Chairman.

Senator Symington, Representative Symington, any other members of the committee who may be present, as you mentioned earlier, I am presently a member of the executive committee of the board of trustees of St. Louis University and chairman of the Standing Committee for the medical center of the university.

My interest in the field of health and hospitals has covered a period of over 25 years. I have served on the board of directors of several community hospitals, and I am currently also chairman of the Joint Board of Health and Hospitals for the city of St. Louis.

I have also served in connection with the United Fund of Greater St. Louis in allocations to hospitals and other agencies here, and I am

rently serving as a member of the Regional Advisory Committee f the Bistate Regional Medical Program and as chairman of the is it muttee on communications and public relations of that program. I deeply appreciate the opportunity afforded me and these other esses to appear before you to discuss the subject of education for ealth professions and several of the problems related thereto. It has become increasingly evident that the need and demand for and better health services has spread throughout the entire country. In the past, different segments of the population have been served est ferent bases related partly to their ability to pay for the health

they believed they needed and partly on their understanding f ..... r need for various health services, both preventive and correce. Mary of our citizens, unfortunately, have either been unaware of services available or unaware of their need for these services. In revent years this situation has received a great deal of attention from e existive and legislative branches of our governments at the Natal, State, and local levels. Unfortunately, this attention has not ...form in all areas of the country.

W: at are the responsibilities of a medical center in this important ana of c.tizen and community needs? I believe that a medical center as several important roles to play. Perhaps foremost, it is responsible f the training of health professionals, including physicians, nurses, • various allied health professions, such as dietetics, medical records, ai technology, physical therapy, radiologic technology, and hosa. administrators. A knowledge in the field of medicine and allied areas has in reased so greatly in recent years, specialized training has

e more and more important. Medical centers have become more -arated, and the costs of training have increased proportionately. Arther responsibility of a medical center is to assist in rendering dret service to members of a community. This includes not only the erst on of its directly controlled hospitals but also assistance in erg service in affiliated institutions.

St. Louis University Medical Center has affiliations with the followgitations at the present time: Cardinal Glennon Memorial Hostal for Children, St. Mary's Hospital, St. Louis City Hospital, total. Veterans' Administration Hospital, and Bethesda Hospital. I value of this association cannot be underestimated. Two purposes vre served, delivery of health services to members of the community a important assistance in the area of teaching.

My own association with the city hospital system, as well as with er hospitals, strongly supports this position. In our own St. Louis Tvety hospitals, I mean Firmin Desloge Hospital and David P. W. Memorial Mental Health Institute, a considerable part of the

rvice rendered, something over $750,000 per year, is rendered on a free or part ally free basis to members of the community who would ** or ab'e otherwise to pay for the service and would, therefore, become a resor chility of hospitals supported by public funds.

A further responsibility of medical centers is the development and t nuance of research studies which relate to the field of both pretetive and corrective medicine. Research of the type I refer to is dre's related to the teaching function, so that the health professionaw. have direct contact wtih research methods and thoroughly unand their importance during their periods of training.

St. Louis University Medical School has always been primarily concerned with the development of physicians who will go out into the community and deal directly with patients. Its emphasis has been in this direction. The programs of our department of community medicine are very important in this respect but represent only one of our relationships to the metropolitan area.

Medical centers also, I believe, have a very direct responsibility in the areas of leadership in a community in assisting consumers to better understand the areas of health needs, to better understand the type of health delivery systems that are needed, to help develop a much better understanding of the importance of preventive medicine, and to more clearly understand environmental problems.

I am particularly interested in the comments of Senator Abraham Ribicoff, former Secretary of the Department of Health, Education, and Welfare, as referred to in the August 22 issue of Saturday Review, regarding the shortage of physicians. It is evident, based on current needs, that for the last several decades the medical schools have been unable to train an adequate number of doctors. It would appear that this has not been because of lack of applicants but rather because of the limitations of physical facilities and adequate teaching manpower. If we are to increase the number of admissions to medical schools throughout the country, it would require a tremendous investment in physical facilities and qualified teaching personnel, but first there must be adequate recognition of the problem and recognition also that it is not possible to solve it overnight.

However, if we do not start toward a solution in the near future, the situation will become more critical in the decade ahead. This is one of the principal reasons why I appreciate the opportunity you have afforded me to testify today before your subcommittee. A hearing such as this one indicate that the problem is receiving increased attention.

How can we meet the finuancial demands? The recent grant from the Department of Health, Education, and Welfare, which was referred to earlier, will be of inestimable value in connection with our construction program to upgrade and update our teaching facilities. This was imperative if we are to continue to qualify as an outstanding medical center. We are certainly grateful for the important assistance. However, the financial demands of current operations continue to present problems that must be solved. The recent article in the Saturday Review by Carl M. Cobb indicated that the cost annually to educate a medical student approximates $11,000. At St. Louis University a student paying full tuition at the present time pays approximately onefifth of that amount. The remainder must be derived from other sources. We have a very modest endowment, the income from which covers less than one-tenth of the annual cost referred to above. Therefore, we are very dependent upon other sources of income, including amounts received annually from corporations, foundations, interested individuals, and other donors.

I do not believe that our situation is basically very different from that of many other medical centers. It is imperative that additional financial support must come from other sources if an attempt is to be made to increase appreciably the number of trained health professionals. I think we will all agree that government sources, in one form or another, must be prepared to supply these funds if we are to accomplish our purpose.

If we in this country are to continue to satisfy the increasing demand fr more and better quality health care, all segments of the community not only recognize the seriousness of the problem but must be ared to cooperate in trying to solve it.

Iere are a number of areas in which more effective use can be made f the more highly trained professionals, such as physicians and registered nurses, and this is where our American ingenuity must be util21 A number of people far more knowledgeable than I have sted the development of a class of physicians' assistants, para

trained as the hospital corpsmen have been trained by our Armed Forces. These could, under proper guidance, serve to meet of the needs of the population, thus reserving for the more exced physicians and nurses service for which their more intensive trang has prepared them.

I am informed that some headway has been made in this matter, part.larly at Queen's Medical Center in Honolulu. One, the operatgroom technician program covers a 6-month period which prepares 2. school graduates to work in the operating room under the direct servis.on of the surgeon or a registered nurse. The second program sintended to establish a group of nonprofessional surgical assistants opplement or substitute for surgical residents or interns in most ture of surgery. Applicants for this latter program-trained surgical a tant program-must have had prior training as a military corpsran or must have completed a certified operating room technician

These are only a few of the areas in which additional experience an be given people who can be very helpful in delivering health Increased emphasis on the advantages of group practice also offers an oportunity for better utilization of our present health profes a. These are but a few of the areas that must be carefully and t.vely explored if we are to meet ever-increasing needs of the er population.

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In closing, may I again thank you for this opportunity to testify fre this committee. Hearings such as you are having here today ecourage me in my conviction that the problems facing all of us are

only capable of solution but are receiving careful consideration A..itdiy

If there are any questions that you or other members of the comtee have, I will be glad to attempt to answer them.

Thank you.

ator EAGLETON. Thank you, Mr. Jackson.

I think if Senator Symington and Congressman Symington agree, we will hold any questions we have until all four of you gentleman Lave completed your statements, and then address the question to the *p, and the individual most qualified to answer can come forth with

answer.

Several months ago, when we were planning these hearings, we rated Father Reinert to see if we could utilize his facilities for the bearings. He said, of course we could, for a slight charge. He is sometimes among nonclerics as Parsimonious Paul. Then when the $2.5 million grant came through, he called back and said, in light of that- and you will appreciate it as an accountant, Mr. Jacksonthought that was adequate compensation.

The prepared statement of Mr. Jackson follows:)