mentary, the whole Federal program in this regard, and you are accurate in the statements you have made.

Dr. HEATH. There is one additional feature to that, too. In spite of congressional appropriations or enactment of legislation that do the job well, there is always the possibility of the program going astray because of administrative decisions lower down, and I cite, as an example of that, the administrative decision in the fourth quarter of fiscal 1970 to allocate only 5 percent of the construction funds to optometry, podiatry, pharmacy, and veterinary medicine when, in fact, 22 percent of the approved but not funded projects under the act were in that same group, so there is a deliberate shortchanging of those professions at this time.

Senator EAGLETON. Doctor, we will include in the record at this point the section entitled, "Summary of National Manpower Requirements," from the Optometric Manpower in Missouri study and the complete study will be printed at the end of this hearing day. Do you have anything you want to add, Dr. Franzel?

Dr. FRANZEL, No, thank you.

Senator EAGLETON. You have been very patient. Thank you for coming.

(The information referred to follows:)

[Excerpt from Optometric Manpower in Missouri, June 1970]

(By Gordon G. Heath, O.D., Ph. D., for the Missouri Commission on Higher Education)

SUMMARY OF NATIONAL MANPOWER REQUIREMENTS

In the foregoing sections we have considered two main aspects of the national optometric manpower situation; (1) the ratios of production and attrition, and (2) the total number of optometrists required to provide adequate vision care to the public. Although the production rate of optometrists undoubtedly reached excessive heights during the late 1940's and early 1950's which produced problems in the assimilation of so many new optometrists in such a short time, the overproduction simply compensated for a long previous period of undersupply, so that the result was that the number of optometrists in the nation rose to an adequate but probably not execessive level. The attrition rate has exceeded the production rate ever since that time, so the actual number of registered optometrists has continually declined. With a steadily growing population, the ratio of optometrists to population has become increasingly more inadequate.

Since 1954, attrition of registered optometrists has averaged 499 per year while the number of optometry school graduates has averaged only 387 per year-a net loss of 112 optometrists per year over that 15-year period. During the same period the U.S. population has increased at a rate of more than 2.65 million people per year, a rate which would require about 350 additional O.D.'s per year merely to care for the increase in population. Thus we can conclude that the graduation of new optometrists during the past 15 or so years has fallen at least 462 per year short of the minimum number needed for the nation. The average graduation of 387 optometrists per year during this 15-year period has supplied only about 45% of the number of new optometrists actually needed to maintain a minimum adequate number of registered optometrists for the growing U.S. population.

Just to compensate during the next 15 years for this deficiency of the past 15 would require a graduation rate of 1311 per year (849+462). However, the attrition rate throughout the coming 20 years or more will be increased by an average of about 170 per year as the optometrists from the post-war overproduction period reach retirement. Hence a conservative estimate of the minimum number of new graduates needed from now through 1985 or 1990 is at least 1485 per year.

As an indication of the relative conservativeness of this estimate, it can be jared to the latest estimate by Mote' that 20,361 new optometrists would be needed by 1980 to meet the needs imposed by growth and attrition. For an 11 year period represented by his projection, this would average 1851 graduates per year.

ENROLLMENT TRENDS

The total numbers of students enrolled in all of the U.S. optometry schools Ne 1960 are shown in Table 4. In view of our previous discussion of the present shortage of optometrists and the inadequate average rate of production of new optometrists since the mid-1950's, the upward trend in enrollments since Ik is encouraging However, even though the total number of students has risen almost to the level reached in 1950-51, it still remains far short of the number need to supply the nation with adequate optometric manpower.

Sources Health Resources Statistics 1968 US Public Health Service Publication No. 1509: Optometry Student Enrollment Survey compiled by Association of Schools and Colleges of Optometry, 1969.

In 1980 the standard optometric program consisted of 3-years of professional courses after completion of a 2-year pre-optometry program. Today the professional courses in all schools of optometry require 4 years. Most of the schools changed from the 3-year to the 4-year program since 1963, so a considerable part of the upward trend in enrollment throughout the 1960's is due simply to the retention of optometry students in school for an additional year.

To produce the approximately 1481 graduates per year that we have estimated are needed as a basic minimum, would require a total enrollment of about 6300 er more students in the four-year program. The total of 2200 optometry students in 1, even though it was the highest enrollment in the past 16 years, still was only about a third of the minimum number needed.

Because some schools have only recently changed from a 3-year to a 4-year professional program, the upper classes are not all filled to capacity, so the se follment picture can be expected to improve rapidly in the next year or two. } .rst year enrollment in 1968 totalled 781 and was very near the maximum espacity of the schools at that time. Several schools are in the process of expanding their facilities and one new school is being established in 1969. But even if the average class size for all schools of optometry is increased to 90 and if all four classes in every school are filled to capacity, the total enrollment eamcity in optometry for the entire U.S. will still only be approximately 4000 lets-less than two-thirds the number actually needed.

To meet the nation's minimum needs in the supply of optometric manpower wald require an immediate increase of some 70% or more in the nation's metric educational facilities. The inevitable delay in developing such increased facilities will only increase the present shortage and require even greater expansion to compensate for the accumulated deficit.

Senator EAGLETON. Our next witness is Mr. A. J. Henley, director, Yeatman Medical Health Center.

If you will hit a few highlights, Mr. Henley, we'd be most appreciative, and we'll print your entire statement in full.

* Mote Herbert G. Analysis of Optometric Needs by States to 1980, the Ohio State Univeratry 1969 (mimeo).

STATEMENT OF A. J. HENLEY, DIRECTOR, YEATMAN MEDICAL HEALTH CENTER

Mr. HENLEY. I would like to say, first of all, Mr. Chairman, thanks for inviting me.

Most of the rhetoric of health care being a right instead of a privilege is just rhetoric. At any rate, I think that certainly we agree more doctors, nurses, dentists, health aides, laboratories, and X-ray technicians are needed. I think that probably training is one of the biggest issues here, and I would like to say that I agree with the earlier statement that courses should be given to all health workers together for at least a year so that they could begin to learn to recognize the value of working with each other.

Certainly there needs to be more community facilities, such as the neighborhood health centers. I believe that medical centers need to emphasize preventive and outpatient care. I think this care needs to be provided in a setting with dignity, and that people do not look upon it as being charitable, because charitable care is generally recognized as being poor medical care.

This summer at Yeatman we did have a very pleasant experience in part, in that a group of medical students, all of whom were white except one, came into our community and began to help us in identifying what we believe to be a lead poisoning problem. These students worked with us, they located children in the area who had lead poisning, they provided and sought out hospitalization for these children, they developed resources to draw and analyze the blood, to educate the parents. I think these are the kind of things that medical school and medical students need to do so that they can become aware of the kind of problems that exist in ghetto areas. These students in turn learn about a preventable health problem. They helped children and the community to do something to begin to correct the problem. I'm sorry to say that some of the response from several of the hospitals was poor. The concern for payment superseded the concern for human life.

The effect of many Government programs designed to assist the education of health workers is, by and large, insufficient. It also suffers from the same kind of fragmentation that we have in other parts of the health care system. It's fragmented with different sections of the Government responsible for different aid programs, different eligibilities and rules.

What is needed is to pull together all health manpower assistance into one section so that plans for health and manpower development are coordinated. On the other hand, while the resources need to be centralized, the actual planning should be at a local level, so that all areas around the medical centers should be represented. A committee of health professionals and consumers, at the local level could best judge the merits of any plan.

As far as solving the problem of maldistribution, special plans to encourage physicians to return to low income areas or rural practice should be encouraged, be they black or white. Special financial arrangements should be given to schools and individuals who elect to become involved in the redistribution of health manpower.

I would suggest that as an alternative to services in the Armed Forces, services to a low income community or a rural area might be sutstituted for some military service.

As far as the need for training more black physicians, I think that one step in that direction would be to have a recruiter of black medical tients in each medical school. Secondly, I think we need to start in 1.25 schools or earlier to let youngsters know that there is a real pos⚫ity of their getting into medical school. I'd also like to state that I think there is a vast untapped resource in our hospitals where qualibed employees could become a tremendous manpower pool to an expan ied medical educational facility.

Many blacks and other poor persons are working in hospitals at lower level jobs than their native ability demonstrates. In every hospital you can always hear statements in reference to nurses aides and fenicians who, in the opinion of most professionals, would make good physicians, but this altogether, most of the time, goes as an unforgotten source.

I think one of the biggest problems in dealing with health manpower is that training is always designed to deal with the diseased body. People will always be in need of medical care unless we begin to structe our training so that we'll teach people to be healthy. We certainly need to train more black physicians and dentists. Certainly the mediahools of this State have a record that would probably even make Mississippi envious. Only a handful of graduates have been produced by all of these schools combined. The usual excuses of, "We can't find them, none have applied, they aren't qualified," have been used for

I think the records will show to date that there have been six or seven back graduates from this medical school. As far as the records indi ate, there has only been one from Washington University Medical tool in the history of the school.

Some of the things that are stated as far as

Senator EAGLETON. Has St. Louis University ever graduated a black Jentist!

Mr. HENLEY. Dentist, never. One black dentist was graduated from St. Louis University Dental School at the graduate level, and I would le to state that that black orthodontist is now the director of dentstry in our neighborhood health center and, incidentally, he's the o. y black orthodontist in the State of Missouri.

To date, Washington University School of Dentistry has not graduated a single black.

In 1950, the dentist population ratio was 1 dentist for every 1,700 persons The ratio now is 1 dentist for every 2,000.

The black community is a separate entity. In St. Louis there are approximately 20 black dentists serving the inner city. The black

ulation is approximately 300,000. The ratio is one dentist for every 15 black persons.

Senator EAGLETON. What is the national ratio?

Mr. HENLEY. One per 2,000. This kind of ratio is appalling and will repare some deep concern and honest efforts in order to bring about a change.

I think the statement that the one black dentist who was graduated from the school of dentistry here in St. Louis University chose to devote a full-time effort to a black community and to a neighborhood health center possibly might point out why we have the kind of problems we have. Certainly most statistics show that graduates from dental school tend to stay in the same city or certainly in the same State in which they graduated from school. Certainly if none have graduated

Senator EAGLETON. Mr. Henley, that depends on the area of the country. I mean, those figures vary quite a bit between Harvard Medical School and others?

Mr. HENLEY. Right.

Senator EAGLETON. Some are much more transient than others? Mr. HENLEY. Certainly in this State it holds true that we only have one, and we have many.

Senator EAGLETON. In the black area at any rate.

Let me ask you a couple of questions about the Yeatman project. Other than the special summer project that you mentioned earlier, do any medical students during the regular routine year, that is from September to June, medical students here at St. Louis University have any on-going contact with Yeatman?

Mr. HENEY. We are, through the department of community medicine, establishing programs for medical students at the health center. We have had this summer, two or three students on preceptorship type programs, working with the physicians and patients in the health center. We have also had two students on assignment to us from the University of Missouri Medical School.

We intend to enlarge this kind of program as we go along.

Senator EAGLETON. How is the Yeatman project funded, basically! Mr. HENLEY. Well, 314E money; HEW.

Senator EAGLETON. Is that 100 percent Federal?

Mr. HENLEY. Yes; 100 percent.

Senator EAGLETON. Is your connection with St. Louis University one of just accommodation; that is, it's the one that was willing to undertake it, or how did that come into being?

Mr. HENLEY. First of all, we did not really approach Washington University. Their record was so appalling until we felt that it would be a waste. We did come here because we knew that there were individuals at this school that were interested. I cannot speak in total for the school. I can speak for certain individuals at this school.

Laboratory assistants, social service aides, medical record assistants have been trained for us at this university by various departments, and they have proven to be as well trained as any I have ever seen. I think these kind of programs have demonstrated what we can do in the areas of paraprofessional training. I personally would like to see a training program whereby inner-city residents could complete courses that would be set up by medical schools, hospitals, and the junior colleges which would include in the design, career-ladder-type programs in order to train paraprofessionals. These things have been done in other States, but to date they have not occurred in this city.

Senator EAGLETON. What kind of manpower do you have at the Yeatman Center, other than M.D.'s?