some kind of contractual obligations with the State for educating physicians in Missouri. Our State falls below the national average so far as its supply of physicians is concerned.

Essentially, then, all of our governmental assistance has been Federal assistance and, without it, this center and most other centers connected with private universities would have disappeared.

I wish here to speak briefly to what I see as a rationale for Federal health support, and then to propose an effective instrument for providing it to institutions that prepare health manpower.

The rationale: The Federal Government, either as cause or catalyst, should take strong and effective measures to see that all of its citizens have the opportunity, as well as the capability, to receive health care. The Federal Government should see that no regulations or lack of funds or other means necessary at community or State levels be allowed to prevent this. I see this as basic, for people move about. They are not confined to a particular community or a particular area. They are mobile. Some States and some communities and cities lack full fiscal resources. But people, whoever and wherever, are citizens and human persons. The rock-down reason why any social institution or program is important is because it answers to real needs of real persons. Persons have an essential importance that measures and explains every social instrument and organization that has significance. If these systems or organizations are not for persons, then, to illustrate from the health care field, professional work becomes meaningless. Research is a sophisticated form of solving jigsaw puzzles, and teaching and service, however we qualify them, are merely some kind of Linus security blanket.

The role of the Federal Government may, then, require the supplementing and reinforcing of local and State resources in the matter of health at the service as well as at the educational level. In all of this, the Federal Government must insist on the common denominator of concern for the human person.

To speak to medical centers and their stability, to insure these, I would urge that governmental support take the form of institutional grants along these lines. To be eligible for such grants, a health professional school or a medical center that trains a variety of people in different professions related to health care and health delivery, would be required to develop, let us say, a 5-year plan, subject to annual review and revision. This plan would include the totality of their effort. Such a plan would include proposals about objectives in terms of enrollment, educational programs, and projected operational, as well as capital, expenditures required to achieve the outlined goals. The plan would also include various sources of income expected from gifts, foundations, tuition, as well as from any community or State support.

My proposal is, then, that the difference between total income and total expenditures be made up by a Federal institutional grant on the basis of an approved institutional plan.

Without going into elaborate detail, here are some of the things that that could accomplish. Such a grant would do away with the present awkward, fragmented, and expensive funding mechanisms. More than that, such grants would permit and still allow institutional flexibility, appropriate institutional autonomy, and close relationships with various publics served, either local or State. This proposal could provide

an effective mechanism for the Federal Government to provide stability to the institutions and centers which furnish the needed health manpower. It could give the Government a much more direct voice in representing the general public and helping by way of incentives and s.pport to develop the kind and the amount of health manpower this try needs and requires.

Finally, it would enable this center and others like it--and there are a number like it-to get about their real business, not of mere survival, but of producing the manpower really concerned for every man's health.

Mr. Chairman, thank you for this opportunity to appear before year committee. If there are questions that you have, I or members of panel will be glad to answer them.

Stator EAGLETON. Thank you, Father Drummond.

Our final witness from the St. Louis University group is Dr. Robert Fex, the dean of the St. Louis University School of Medicine. Dr. Felix.

STATEMENT OF ROBERT H. FELIX, M.D., M.P.H., DEAN, ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE

Dr. FELIX. Mr. Chairman, members of the staff, gentlemen, I am pleased to have the opportunity to appear before you. As a matter of fat, as I have been sitting here listening to my colleagues talk and to those who preceded them, I have had a strange feeling of nostalgia steal over me when I think of the 20-odd years that I testified before tommittee when I was in Washington with the National Institutes of Health.

Senator EAGLETON. Doctor, did you give the same testimony and we gave you the same inattention? Has this been a 20-year stand fast

Dr. Fruix. No Senator. I always figured that if I could say someg sufficiently upsetting, challenging, irritating, they would quit g and listen to me.

Segator EAGLETON. Irritate me, Doctor.

Dr. FELIX. If I couldn't, it was all in my prepared statement anyway, I didn't lose anything.

I remember, though, those wonderful days many years ago when the then chairman of this committee in the Senate, my dear friend, Lister H. from Alabama, and his opposite number in the House, the late Cor gressman John Fogarty, were concerned with how to do just what we are talking about now. We were able to work with the House, with The Senate, with the administration to develop much better and er programs for the people of this country. I felt a little home

- I say, as I heard my predecessors speak.

I am on record in a number of places and a number of times about e situation with regard to medical education generally, and St. Louis Iversity specifically. I suspect that I even make some of my col

es and some of the alumni a little nervous at some of the things I ay Hut as the umpire said, I can only call them as I see them, and I no harm can come from speaking the facts as they are. Our challenge and our problem here at this school, as in many other tools, is how to save time, how to teach all that we must teach, and

how to increase the output of physicians, without in any way compromising the quality of medical education.

This would be fine if we were able to finance an adequate curriculum, adequately staffed. But every time we get a grant of an institutional nature to help us move forward a bit, we are told we must take more students, which means that we are back to where we were, if not behind that point, with regard to the number of faculty for the number of students.

I think there are ways that this can be met, and I would like, with your permission, Mr. Chairman, to address myself to one aspect of this problem and try to suggest a possible solution. There are others, I know, but the time is limited, and I would like to take just a few minutes to do this.

I am sure that what I am going to say will not be agreed to by many of my colleagues, many of whom are more competent and more distinguished than I by far, but out of disagreement comes dialog, out of dialog comes exchange of information, out of exchange of information can come plan and design, and maybe out of this somewhere, somehow, we will be able to attack this problem, at least on an experimental basis. I would be less than candid if I didn't tell you that I would like to be at the place where such an attack will be carried forward. I have been fighting the establishment as far as the way things have always been in health care and other similar situations for 30 years and I am too young to stop now.

The student's introduction to medicine traditionally has been via the basic biological sciences in which he has been required to be reasonably proficient before he moved on to the diagnosis and treatment of patients. One cannot properly evaluate suspected disorders of the body or mind nor institute effective steps to prevent illness unless he has a good knowledge of those phenomena which allow us to live and breathe and think and defend ourselves against nature's onslaughts. This knowledge, in my day, was imparted to the medical student early in his career, and such subjects were often taught for their own sake alone and without too much regard to their application in the living, breathing patient. As time has gone on, we have modified this a great deal and have brought more of the clinical subjects into the basic science years. This has been, I think, a very constructive step forward. More students are interested in clinical medicine now than was true even 10 years ago when the greatest glamour was attached to research.

In our school, for instance, I have recently appointed a committee of the faculty to examine critically and in depth the role of the basic sciences in medicine. I have asked this committee to examine both the content of the courses and their methods of presentation. What we are really looking for is time which can be saved and can be directed to some of the more recent innovations in medicine, such as patterns of health care, how you deliver health care to patients, how can you improve proficiency, and so on.

I appointed this committee because one possible way, and the one on which I would like to spend some time in talking to you, would be to shorten the amount of time the students spend in medical school studying the basic sciences: anatomy, physiology, biochemistry, microbiology, and so forth.

If we can shorten this time, then we can use it either for teaching er esential material or we can shorten the course by that amount of time, or we can share the space with other courses, because laborary space is the most expensive and also largest in square footage .. the medical school. We could utilize this space for teaching more students the basic sciences by teaching more than one laboratory sec ton as we would then teach using a revised curriculum. We could, let ay, add 25 or 30 percent more students to our classes. Whenever you consider enlarging enrollment, and this is true in

hool at this moment, one runs into the problem of limited oratory space. Clinical space is not so precious because in addition to our hospital, we have other hospitals with which we are affiliated, and there are other hospitals in the community where affiliations d be effected if it were in the best interests of medical education. Most of the students coming to us now know as much genetics or Lemistry or microbiology or physiology as the medical student 4 years ago knew when he had completed these courses in medical Cool. Perhaps a modified and more applied course could be taught nal school which would, in addition to the basic scientists,

ze clinicians who are well prepared in the basic sciences, and this wd give more clinical relevance to these subjects.

It wou'd also, as much as anything else, impress upon the student fut that he must constantly keep abreast of the basic sciences in particular field and not rely on the material as it was taught to him. the time he was a student.

Ie time that could be saved if we could recapture curricular hours

devoted to the basic sciences could be devoted to demonstrations a 1 a tual experience in the delivery of health care by the student. We are all well aware that the great public need is for more practic2 pystans, particularly physicians who can serve as a primary tea resource for the entire famly. Such physicians would not only

verned with the treatment of illness, but would also, and in some 21 more importantly, be concerned with the prevention of disease asalality, that is, with health maintenance. If students are to be vssted to enter this type of practice, they certainly must have an 4'e exposure to it and under conditions such that they will te work exciting, challenging, and respectable.

I they do by working under preceptors and other instructors in tual delivery of health care. In accomplishing this purpose, the

bool really achieves its four great missions, which are: To a ay deliver health care, because this is necessary for teaching: to a leadership role in health in the community, by virtue of its stereouse of knowledge and the experts on the faculty; to engage in

g the next generation of professionals; and to add to the total ... of knowledge through the research it carries on concerning the very of health care and seeking the answer to health care prob

A small example of what I am talking about might be helpful at point. Not long ago, our department of community medicine, and 1. wil hear from our chairman a little later, received a grant for purpose of studying the problem of lead poisoning among children of the areas of St. Louis. Students were recruited to work with faculty on testing the children, contacting the families, and gather

ing the data. The problem as it unfolded was discussed in seminars and lectures with the students, and the clinical syndrome of pica, which is a condition which develops when children have ingested lead, was discussed and demonstrated a number of times and in a number of contexts. The Yeatman Community Health Center, where this work was carried on, took the next step by informing the public of the situation. This aroused a great deal of community interest and was the subject of news stories and comments in our very excellent press in St. Louis. I am sure you would agree with me that few cities are blessed with such an excellent press, and I include in the press here the radio and television.

The result was an aroused public opinion, which, it appears at this point in time, will result in community action to eliminate the hazards and prevent the condition occurring in the future.

Our students saw this health program in all of its stages, from the design for the collection of data to the public action and the results. I know of no teaching which can be as effective as this. This was a laboratory in the best sense of the word. We need a great deal more of this kind of teaching, but it requires personnel and personnel cost

money.

At the present time we have reached the saturation point insofar as our teacher-student ratio is concerned. We cannot improve the situation because we haven't the funds to do it. We are admitting this fall the largest class since I have been dean here. We will admit 141 new freshmen, which is 10 more than were admitted last year, and, I might add, 10 of those freshmen are black students. If these students are to receive what they are capable of absorbing

Senator EAGLETON. What percentage of last year's 130 admittees were black?

Dr. FELIX. Two, two students.

Senator EAGLETON. Last year 128 white, two black. What is it this year?

Dr. FELIX. 141 students, 131 white, 10 black, and we expect to move from that point forward as we have faculty.

Many of these students, these 10, have educational deficiencies such that they are going to require some special attention. This means more of a person-to-person kind of teaching, and will require more personnel.

Senator EAGLETON. Is it person-to-person teaching in the sciences or even beyond the sciences?

Dr. FELIX. More in the sciences, Senator. I would hope that by the time the student becomes a junior, he will have come abreast, as far as the underpinning material is concerned, with the rest of his class, so that from then on it is every man for himself. I might say that our experience here over the last few years has been essentially no failures after the second year of school.