Today there are 315,000 white physicians; and if every black physician trained since 1865 were still alive, we would still be more than 12,000 short. Negroes constitute 11.4 percent of the nation's population, but only 2.2 percent of the nation's physicians.

A recent study in Missouri showed that in 1920 the rate of MD's per Missouri population was 172 doctors for every 100,000 population, well below the national ratio of 139 per 100,000. Missouri ranks 13th in population in the United States, but 40th in number of entering students per 100,000 population. Only an 8.2 percent increase in physicians is expected in the state during the next ten years; while the population is expected to increase 15.9 percent.

When I first came to St. Louis in 1940, there were approximately 100 Negro physicians in the Mound City Medical Forum. In 1966 the number had dwindled to 66. After three or four retirements or semi-retirements, two natural deaths, and two murders, the number dwindled further to 59, not counting the ones that moved to East St. Louis, Illinois because they could not get hospital privileges in St. Louis, Missouri. Today, with approximately four additional physicians settling in the City in the past year or two, the number has risen to approximately 61. In St. Louis, with a population of approximately 725,000, there are only 1400 doctors in the St. Louis Medical Society. So, even in an inner city situation where an inordinate percentage of the city population is black, only 4 percent of the city's physicians are black. This disproportionate low percentage of black physi cians in the United States reflects the inequities and inadequacies of our educational system, both primary, college, and postgraduate. But this is just one of the shameful results of the activities of a racist society that we experience here in the United States; a racism that prevents the implementation of a ruling of the Supreme Court to desegregate schools for 16 years. A racism that prevents a grieving mother from burying her son in a white cemetery; her son, who was killed in the Vietnam War fighting for his government.

At the Seventy-Third Annual Convention of the National Medical Association in Houston, Texas in August, 1968, President Johnson called for the immediate expansion of the medical schools, terming the overall shortage, and particularly the shortage of Negro physicians, "a complete indictment of our educational system." The President said it is a tragedy that only one in 5,000 Negroes becomes a physician, compared with one in 670 for whites. The answer to this, of course, is while plans are being made to graduate more doctors generally, they must include plans to graduate a proportionately larger percentage of Negro MD's.

Most medical colleges and schools of medicine are incorporating programs for the admission of a larger number of Negro medical students in the freshman classes. Some of these programs are intensive, and incorporate enrichment programs and financial support in the form of scholarships and student loan funds. Whereas, other schools have programs that are not so intensive, nor not backed up by financial support. Twenty-one of the 101 medical schools in the United States have no programs to enlist black students in their freshman classes.

Mr. Chairman, as you and the members of your committee well know, there are simply not enough medical schools. The Surgeon General of the United States Public Health Service, in 1968, Dr. William H. Stewart, stated that even if present plans to build 20-25 new medical schools by 1975 are all fulfilled, the current physician population ratio can be maintained only with the continued licensing of about 1600 foreign trained physicians a year.

As Senator Abraham Ribicoff, former Secretary of Health, Education and Welfare has observed: "This year alone medical schools turned down 15,000 well qualified students who wanted places in the freshman classes. There was only enough space for 10,000". This accurately depicts the dire need for expansion of medical school facilities to take care of the applicants for medical education. However, on a regional basis, the picture may be even worse in certain areas.

I served on a special committee of the National Academy of Science, charged with the responsibility of studying untapped resources for medical manpower, and we proceeded on the assumption that for every 15 applications to medical schools, only one was accepted across the board in medical schools in the United States. Of course, we realize that because of multiple applications per student, the number of students applying and the number of applications received are not necessarily synonymous.

In view of the time required to plan and to build, staff, and to begin operational status of a new medical school, plus the four years to graduate the initial

*ering class – this lag of time is too slow even to keep current with the increas*pulation and therefore the increasing doctor-population ratio.

I therefore submit that while new medical schools are being planned and gbolt that crash immediate programs should be instituted in all states tang existing medical schools, to immediately subsidize expansion programs • these existing schools and thereby in a period of four years, a consider℗ irurease in physicians graduated can be obtained.

Inmher submit. Mr. Chairman, that with 15,000 well qualified students ap₫ for 10 000 places in the freshman class of our medical schools, the black med mi whool applicant is lost in the shuffle. He is lost because in our known st society, discriminatory and dehumanizing practices still exist in our ary and secondary educational facilities, housing and occupation opportunot only in the south, but in the north, the east and the west of our supjesi'r democratic nation As a result of this, the black medical school apis deprived of academic and cultural background, as well as economic rt from his family; to say nothing of the lack of moral support from his family and community. Therefore, he is inadequate to compete for those ❤ psitions available to enroll for medical education. The MCAT (Medical •ge Admissions Test) has been condemned by the Sloan Foundation workand by the National Academy of Science, and by many other authoritafire bexlies to be in effect discriminatory against the black students, and forms a fruitable barrier to the black medical school applicant. For more than two recommendations have been made from various sources that the MCAT be

ete efforts by many medical schools over the past two years to increase ror'ank enrollment, the percent of black medical students enrolled in their a, colleges still hovers about 25 percent. In a joint survey made by the otal Medical Association and the American Medical Association and another 12@AAMO this conclusion is confirmed.

Hesse of the inequities in the statistical proportions of black physicians, --- of the racist and discriminatory circumstances that exist in our ary and secondary educational system of these United States, and because resugiüzed over all shortage of physicians, and because of the acute shortPysctans in our ghetto and rural areas, I submit to you gentlemen that i state governments require and subsidize all medical schools to have rized programs to admit more black medical school applicants to their at, class in the immediate future.

A

I have stated for a number of years over and over that universities and of medicine should make their curricula and programs and their inIL-re relevant to the needs of the community about them and to the the people as a whole throughout the nation.

a. boos are the main arbitrator of our Regional Medical Programs chout the country, as here in St. Louis at our Bi-State Regional Medical an. Bit many Regional Medical Programs do not have representation ves gnized Negro medical organizations as required by PL 89 749. Imi, ai mbools have become involved, stimulated by student health organizain neighborhood health centers which have been developed over the past to three years under OEO and the Department of Health, Education and Vai al whools have become more involved in community programs, a policy n. I have urged so long. Medical schools have always been intricately inred and have played in integral part in the staffing of City hospitals and "ganization of intern-resident training programs in our City hospitals. rvolvement has been effective and successful în direct proportion to their s to extend their faculty staff, and has been limited to some degree in «»t n'mber of years because of the acute manpower shortage and because ulated resources of the city government to provide space and facilities arch projects and teaching at the city institutions.

ost important evidence of change of posture of medical schools and in relation to the community has been the development of departof community medicine in various medical schools across the country. y we have the Department of Community Medicine of St. Louis University, g Dr Max Pepper; and the Department of Health Research at WashI Liversity under the Department of Medicine, headed by Dr. Gerald

The emergency and out-patient departments of medical school affiliated hospitals have always given direly needed and outstanding service to the communities in which they are located. But in recent years these have been expanded by out-reach programs, bringing services to the disadvantaged areas and the ghetto areas of our cities, and rural areas. These out-reach programs servicing the poor and the disadvantaged vary from school to school in direct proportion to their financial ability to maintain such programs and without federal subsidy many of them would be impossible.

Junior and senior medical students in various medical schools are undergoing preceptorships in local physicians' offices, as well as working in comprehensive neighborhod health centers. In many instances they have developed extensive programs to provide medical services in the form of clinics, initiated. organized, staffed and run by medical students in areas of the United States where no medical facilities are available at all; such as the Mississippi Project, instituted by the Student National Medical Association, and the Appalachia Project, instituted by the Student American Medical Association.

Since the tuition fees paid by medical students constitute only a small percentage of the over all operational cost of medical schools, funds to operate the school and to carry on their various programs outside of the medical school must be funded from some source; either by private contributions and endowment funds, alumni support, or state and federal subsidy for expansion of their facilities and the operation of their academic and other programs.

We understand and support President Nixon's move to curb inflation by cutting federal spending. But we hate to see the end obtained at the expense of the health of the nation, and at the expense of depriving needy students of financial support to go to medical school. In President Nixon's budget as it went to Congress in January, 1970 he sought $15,000,000 for health profession scholarships. But under 42 U.S.C. 295G (B), he could have sought $16,800,000. Therefore, he only sought 89 percent of the amount he could have requested. In other words, he sought 11 percent less than the law permitted. Under HEW regulations, 42 C.F.R. 57.604 (A), when the funds are less than that contributed on the basis of $2,000 × 1/10 of full enrollment, then grants to all schools shall be proportionately reduced. When President Nixon cut the appropriations approved by Congress to the Department of Health, Education and Welfare by $7,000,000, we in the medical profession were all shocked and disappointed, because we realized what effect it would have upon the various programs of medical schools to expand their facilities and increase their programs for enlarging the number of medical school graduates.

I would, therefore, recommend that the Subcommittee use its influence in attempts to obtain full grants and appropriations for health profession scholarships and expansion programs as previously authorized by Congress.

As you know, Mr. Chairman, there are approximately 14 to 15 "have not" medical schools in the United States of the total 101. At a recent meeting with President Nixon, Secretary of Health, Education, and Welfare, Mr. Elliot Richardson, and Mr. Robert Finch. I was a part of a delegation from the National Medical Association. I was asked by President Nixon whether I felt that the schools in direst need should have priority in available appropriations and funding grants. My answer to the President was a definite "Yes." It is understandable since these schools have been in the past constantly threatened with the possibility of closing because of fiscal incapability of continuing, and at best have been operating under great duress. Furthermore, in many instances these schools, such as Howard and Meharry, have a higher percentage of disadvantaged poor and black students. And if they close, not only will the total number of enrolled medical students and medical school graduates be decreased, but the number of poor and disadvantaged and black medical student enrollment will be very definitely adversely affected. So I humbly recommend that this Subcommittee support this stand.

As a member of the Health Task Force of the Urban Coalition, in our report of July 1969, we referred to the matter of putting more people to work for improved health services. We stated that "whatever is accomplished in improving the delivery of health services to the urban poor will be conditioned by the availability of manpower. Part of the inadequacy in applying our health resources is the lack of sufficient manpower, and part is the inefficient and ineffective use of what manpower we have. Manpower critical deficiencies cannot be remedied by producing a host of additional professionals who require long years of training. Rather, professionals must identify what part of their jobs can be done by someone with less training, and what part must be done by people with

more advanced training, so that a hierarchy of staffing can be established. Then De a 1 led sub professionals, those people lacking professional degrees, can be ed to enlarge the system of care."

metel spment of new careers through training for jobs that did not previ>xist in the health professions would produce more sub-professional trel to remove part of the burden of care from the professionals, stretching „atter is availability in improving the over-all productivity of the system. It d santaneously create job opportunities for the poor and the disadvantaged 2**@ cut munity " Many new health careers are begining to be identified, such as, The pervadintis assistant, surgical assistant, the operating room technician, the wami merk, the inhalation therapist, and many others.

In a view of the Health Task Force of the Urban Coalition should be eno 23 endorsed by all of us professionals and by this Subcommittee. last year and year before last, I attended the meetings of the Council on Medical Graduates of the American Medical Association, and found imaible to attend their meeting this August 31, 1970. Suffice it to say that this *** compex subject, and one that cannot be clearly discussed at this hearsa ase of its many ramifications. However, if it were not for the thousands • æn medical graduates who enter this country each year, many of our :s and communities would go without medical services that are badly 1 Many of the foreign medical graduates are extremely unhappy about the they feel they are treated in a discriminatory fashion, and are not given the toties that they feel they deserve. In many instances, I feel that they have ful complaint. Most of their complaints arise around the matter of licenard in most instances, the foreign medical graduate has great difficulty .g the State Board Licensure Examinations. And as you know, the State -ari examinations vary from state to state from one part of this country to

1 recommend only that some standardized techniques be developed to -ste the foreign medical graduate before he comes to this country; that stardized tests be devised specifically for the foreign medical graduate in er that be can move with even flow through his training into active particimeheal care delivery in this country if he desires to stay. Subjects asma distribution and utilization of military trained technicians and DELETE STE Some not touched.

Chairman, I apologize for the lengthiness of this testimony. All that I 1.1 has been in good faith, with a hope to be helpful in the expressions TORT CORVictions on certain subjects, and in trying to touch on certain that I was apprised you would be interested in hearing. I thank you for ng me this opportunity to appear before you.

Stator EAGLETON. Mr. Mosley.

Mr. Mey. We have a brief statement we would like to read, since ta prepared statement.

of all, I would like to thank Dr. Whittico for giving us this cenity to speak, and also thank you, Senator, for allowing me as resentative of the Committee for Black Health, St. Louis chaptrofe Student National Medical Association, to speak to you today. ator EAGLETON. Please proceed.

STATEMENT OF JULIAN MOSLEY, THIRD-YEAR MEDICAL STUDENT, WASHINGTON UNIVERSITY

Mr. MOSLEY. I feel that we should be voicing an opinion at this meetthe Committee for Black Health numbers among its memof the black students at St. Louis University and Washington ty Schools of Medicine, Barnes Nursing School, Washington ery School of Hospital Administration, the majority of black - from the St. Louis University-affiliated hospitals and WashUniversity-affiliated hospitals, and the interns and residents ner Philips Hospital. Therefore, we are all involved in some pe of medical education presently.

We have spoken with many of the people who are testifying before this committee about specific programs and projects that we feel will help solve the problems of increasing the number of blacks in the health careers fields, but now I would like to talk about generalities that I think are being overlooked in the attempt to revamp medical education systems, especially as they concern blacks in this country. The Committee for Black Health, St. Louis chapter of the Student National Medical Association, will be more than willing to discuss specifics at some other time.

If the problem of providing medical education is as serious a problem as it is said to be, I think it is certainly an acutely serious problem in the black community, which has a disproportionately small representation in all the medical allied fields. If the problem of medical education is a difficult problem to solve relative to white medical students, it is an even more difficult problem to solve for black students. That is one of the reasons this organization has been formed, to make committees such as this and institutions like the medical schools and dental schools in this area aware of how this difficult problem might be solved and how it is a different problem.

In speaking about the three broad areas that are involved in the health manpower problem, recruitment of black students, retention of black students in medical schools or allied schools, and the utilization of black students in these institutions, let us state a fact.

I think blacks who are already in, or associated with health career fields, will have to bear the burden of recruiting future blacks. For example, the 10 black students entering St. Louis University Medical School were recruited mainly through the efforts of black medical students at that institution this year, and the four black medical students entering Washington University were recruited, similarly, through efforts of black students at that university. Why must black recruit blacks? Because the credibility gap in this country between blacks and whites, in this instance between black students and white institutions, makes it imperative that blacks confirm the intentions of white institutions. This implies that there must be a real attitudinal change within these schools. No longer can schools say that they are looking for blacks and subsequently demonstrate that they are really only looking for a token number. This change of attitudes must permeate the entire institution, so that the black student once enrolled does not feel outcast, persecuted, or deprived because he is black. The institution must be willing to go out of its way to provide financial assistance and, in most cases, financial needs of black students are greater than those of white students. Likewise, if necessary, the educational needs of these black students must be provided for, to enable them to complete their education. It follows that the more black students admitted and retained now, the more sizable the growth will be later. As well as retaining students, institutions must be sensitive to the needs of all black people, which probably means the alteration of curriculums, so that students will be better prepared to serve the community in which they live.

It must also provide vehicles for students to be of more service to the community in which they are residing. This is another illustration of an attitudinal change in the medical institution which formerly has been academically orientated, but which now must become community orientated. Already we have heard people speak specifically about the things I have just generally reviewed: recruitment, admission, reten