ton, curriculum, financing, and community orientation. The difference stat I have been talking about the need for a real change in attitudes ang white institutions that will have to come about in order that ay of these erudite schemes so far proposed, or programs so far put fre this committee, can work.

No longer can a white person be satisfied with being the most liberal or openminded person at his institution, willing to accept a few blacks were there were none before. This is a time for proof, not token tentions of getting more blacks into medicine.

I be Committee for Black Health, the St. Louis chapter of the Studet National Medical Association, feels it is important enough to be ed by the members of this group, and your ineptness in not realizing does not, I hope, reflect an inability in solving the problems with oh you are trying to cope.

In stening to the testimony that has been presented at the hearing tay, I think the Committee for Black Health has the feeling that we could have added to some of the testimony provided before the

ittee, especially the portions that concern black people, and we fet that some questions were answered inadequately; therefore, we d like to try to add what we felt about them.

Ore that I felt should be corrected or at least amended, is the tion which has been bandied about during the hearing, concerning were the black M.D.'s graduated from predominantly white instittons practice medicine, that is, the suburbs? I think

nator EAGLETON (interrupting). I cited as the only figures I have that those pertaining to Johns Hopkins in Baltimore County, Md., t I don't claim that to be the national result. I don't know. Those were the figures supplied me from Johns Hopkins.

Mr. MOSLEY. This is obviously a question that in our efforts to rease the number of black students in the various medical instituts we have had to answer for 2 years, and I think we probably have ce different answers than the ones you have heard already this

Tillg.

I think you cannot make where he is going to practice a prerequisite of the student's admission or entrance into a medical institution

- there are other areas of need in the black health problem 1 Just ghetto medicine. There are blacks at all levels in this Nan, and there are many medical needs among blacks, especially areas such as academics and research, which have not even been f. ced on yet.

ator EAGLETON. Ninety percent of all blacks live in racially ated neighborhoods. Those are the national census figures released. If ev be accurate, then if 90 percent of the black people live in aron, the fringes of which would not be necessarily ghetto-like, „t the inner core of which would obviously be ghetto-like, and I ■d say 90 percent of black people have about the same kinds of

es as the average white guy, and some have heart disease, and have piles and some have hemorrhoids and some have hangnails. -t it stand the test of reason that medical services are going to delivered to the people!

Mr. MOSLEY. I think you are missing the point, namely, black

as provide care for the black community, and where the physias resides is irrelevant to his delivery of health care. It has been

pointed out before this committee that 90 percent of the medical care delivered to the black community is from black physicians.

Senator EAGLETON. Do you think that is the case in St. Louis?

Mr. MOSLEY. That is the case. I defy you to name me a black physican who is making his living from white patients.

Senator EAGLETON. I don't know that I can. I agree with you. So I am not getting what you are saying. If it is primarily that black doctors are, by and large, rendering medical care to black people, then isn't there some relation, not that you can pass a Federal law "thou shalt not work in this neighborhood," don't we have to pump more black physicians through the medical process, nurses, the whole bit, so that we can get some medical care to the black people?

Mr. MOSLEY. That is true. I think we have to pump more black physicians into the mill so that you can solve the problem.

Senator EAGLETON. I don't think any of the previous witnesses disputed that.

Mr. MOSLEY. I think the onus of your previous statements was that many of the black physicians were denying their obligation to serve the black community and I think that is a mistaken judgment. Some of the other people here on the panel might have something to add to what has been said.

Senator EAGLETON. Thank you, Mr. Mosley.
Miss Scruggs.

STATEMENT OF KAREN SCRUGGS, SECOND-YEAR MEDICAL

STUDENT, WASHINGTON UNIVERSITY

Miss SCRUGGS. As I was listening to you, you mentioned also the small number of physicians who were taking advantage of the "Waiver of Indebtedness" section in the Health Manpower Act and what not, and you wanted to know why didn't more physicians avail themselves of this and go to work in rural communities which were depressed.

Senator EAGLETON. Rural or urban, wherever there is a need by a standard form, an index of poverty, and an index of a shortage of medical manpower.

Miss SCRUGGS. It seems to me that often, people in medical schools who are interested in getting more students and training them specifically to go back to ghetto areas are expecting more humanitarianism of minority group members than they are expecting of the population generally. The minority medical students and other professional students have the same sort of economic pressures to getting ahead in our money-oriented society, as do the white students. Until we can— throughout all areas of our life-impress upon Americans generally the idea that we should become more humanitarian in our outlook and in the way we use our money, our time, and our resources, it is not exactly fair, in my opinion, to stress the fact that the minority and other disadvantaged students, who are going into the professions, have not gone in droves back to the situations from which they came.

Another thing I think which might be relevant to the discussion of the black physician or the black lawyer's movement, or any other professional movement out of his ghetto environment into the suburban area or into a more lucrative practice elsewhere, is that

Senator EAGLETON. That is only a movement, isn't it, ma'am, of his prenal place of abode! It is not a movement of his clientele.

Miss Scruggs. That is right.

Sator EAGLETON. As the doctor pointed out, less than half a peret of his clientele is white. I know a whole list of black lawyers in St Lous, and I doubt any of them have a white clientele. One lives 1. Seth St. Louis, a lot in St. Louis County, but where they live and were they practice are different things.

Miss Sertogs, Yes, it is. It was not clear to me that this point got a rims earlier in the day. What I wish to say with regard to recruitrest of minority people, in terms of money for recruitment of these pepe, is that we will continue to have a shortage until there is even Eresus.dy of minority group medical students because, in addition aving to support maybe wives and families and debts left from ze, often students have younger brothers and sisters-who have sard their educational opportunities to allow them to start medical ¡-who must receive, or wish to receive higher education. This thing that wasn't mentioned by Dr. Felix who addressed him

to this issue.

Ator EAGLETON. What training program are you in, for the ཤྲཱ ཐཱ་

M » Scruggs, Second-year medical student at Washington Univerand I am the secretary of the committee.

ator EAGLETON. Is St. Louis your home?

Miss Scruggs, No; I am from North Carolina.

stor EAGLETON. What town?

M » Scruggs. Selma, a small town, about 2,500, in the eastern part

State.

ator EAGLETON. I guess you haven't picked your specialty? M → Scruggs, No; I have definitely decided to go into community ne, probably a speciality in that sort of program.

Serator EAGLETON. Probably not back in Selma, though?

V » SCRUGGS. It depends on whether there will be a community The type of orientation there by the time I have finished.

ator EAGLETON. Very good.

Ian you, ma'am.

Yer: Mr. Bond.

STATEMENT OF WILLIAM BOND, SECOND-YEAR MEDICAL

STUDENT, ST. LOUIS UNIVERSITY

M-END. The committee has put together sort of a proposal that we il se to be read into the record, dealing with mechanisms that et into effect to recruit minority students, recruit additional

rity students.

Aw, this past year most of the recruitment was done by the stu

tting at the table. In other words, the institutions because of, say, their orientation or because of, let's say, their outlooks and es, were unable to recruit the students and so much of the work a: to be done by students taking time off from their course of study eler to do the recruitment job that was run this past year, and this ald just like to sort of read into the record.

Senator EAGLETON. Can you highlight it for us and the whole thing will be in the record.

Mr. BOND. Basically, we have four basic topics. It deals with the identification of students, it deals with the modifications of curriculum that have to be instituted in the medical centers in order to have more black students coming into the medical centers here in town.

Senator EAGLETON. Does that relate itself to certain tutorial and remedial services?

Mr. BOND. Partly. This would include part of it but, at the same time, I also tend to feel that you have to have a broader revision of curriculum, as well as increasing the size of the medical school class. The medical schools in town graduate approximately 110 to 130 students per year; at this rate, the health manpower crisis in this area will not be solved. We have 10 black students this year at St. Louis University; however, if, let's say, there was a curriculum revision where the school could graduate two classes in maybe a 6-month period, in other words, start a class in September and one in January, then we could graduate up to 50; maybe 100 additional black students per year. However, to do this there would have to be a broader revamping of the curriculum than is at present being given.

At the same time, you also have to have a community based orientation built into your curriculum. At present, curriculum orientation deals basically with training at the medical center. This doesn't give a student any orientation to the type of medical care that he should also be getting, that is at a community center, much like the Yentman Center in North St. Louis.

I remember hearing the doctor who spoke earlier say that he would not practice in this type of setting. Basically, the reason why he wouldn't practice in this type of setting is the fact that he hasn't had the exposure to begin with.

This summer, a number of students

Senator EAGLETON. You heard him tell, in all fairness, that he thinks he was overexposed. You mean the intern, Dr. Fiordelisi?

Mr. BOND. Yes. His exposure, he is viewed, let's say, by the community as really being an outsider, and being an outsider and not knowing the people in the community, not knowing, let's say, the organizations that exist; not being able to even speak to the people on the block, it is understandable that he had troubles. If he had more of an orientation toward, let's say, getting out on the street, getting to know the people, working, let's say, in a community orientated center, he wouldn't have had the troubles that he had. Many of the students that worked this summer around the city, in the community, didn't have the problems that he had; so you know his whole orientation toward life is wrong.

Now, going on into modifications of curriculum, I think what is needed really is a community orientation toward the curriculum, and this would include, having consumers, professionals as well as students present when the curriculum is set up. This is the only way that you are going to implement a curriculum that will be meaningful. We can go on to thoughts concerning moneys, let's say, for medical education. At present many of the black students here would not be here unless we have a scholarship or a fellowship, had taken loans and things like this. The taking of loans is not something solely in

sive to black medical students. Granted, white medical students have take loans also, however, it puts a greater burden on us to take a arge number of loans, because we have to go back into a poor com*in ty to practice in; having that great debt over our heads doesn't te patters Not only do we have to take additional high interest e ioans to build our building, but we are at a greater disadvantage „t'at we can't get any insurance company to insure our building for va: 15 sm. So what I am saying is that you are going to have to have aronder base in terms of the type of financing that a medical student ng to have.

o finance medical education, what I would specifically propose is, et's say, that the Federal Government should, in essence, finance the al plant, and let the private sector come up with the moneys, ay, for students. It would not hurt a physician to kick back $500

** into a general pool or fund. This, in essence, would mean at you would be able to finance medical education received by stuts and, at the same time, providing incentive to the physician, by gang him a tax break for kicking moneys back into this pool. You st, nk that the rationale in this is a bit off, but when you actually A about it, it isn't. Think in terms of the dues that white doctors to the American Medical Association. I am sure you know $500 ** to the A.M.A. is cheap, really. The last point that I wouldator EAGLETON (interrupting). I might say on that point, I don't s the exact figures, but in terms of capital construction facilities, development of new medical schools as in Kansas City, or the exon of existing medical schools, as the one we are in now, you will at a very substantial percentage of capital improvement grants e from Federal and State matching funds. Am I correct on that, Fater Drummond?

Fat....er DRUMMOND. That is quite correct.

rator EAGLETON. In Kansas City right now, there is very little ate money going into the building of the Kansas City Medical

.

Mr BOND. Well, thinking in terms of that particular rationale, I suggest strongly that the Government could afford to open 1 fional centers in this area. Let's say, if they could get out of their tin Vietnam, I mean, you know, this is somethingrator EAGLETON. You and I won't disagree with that. Mr. Bonn. Now, going back to my third point, which is the return te community, many black doctors have an obligation in terms of raft once we graduate, and I think Dr. Nichols still has his obliga4. If he could forego that time spent in the armed services and, let's a. that could be 2 additional years, he could get into the community ears earlier than he would normally if he had gone in the Armed Febrst; and so, I would say that black doctors ought to be exempt

the draft, because the community, the people that are where it's 1. the services more than the Armed Forces, let's say, in Vietnam. rator EAGLETON. You are aware, of course, that there is a disproorate number of black military personnel in combat in Vietnam. Mr ND. This is true.

Mr. Nichols.

Mr. NICHOLS. I am a resident at Washington University Medical

ter.