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currently serving as a member of the Regional Advisory Committee of the BiState Regional Medical Program and as chairman of the committee on communications and public relations of that program. I deeply appreciate the opportunity afforded me and these other witnesses to appear before you to discuss the subject of education for the health professions and several of the problems related thereto.

It has become increasingly evident that the need and demand for more and better health services has spread throughout the entire country. In the past, different segments of the population have been served on different bases related partly to their ability to pay for the health services they believed they needed and partly on their understanding of their need for various health services, both preventive and corrective. Many of our citizens, unfortunately, have either been unaware of the services available or unaware of their need for these services. In recent years this situation has received a great deal of attention from the executive and legislative branches of our governments at the National, State, and local levels. Unfortunately, this attention has not been uniform in all areas of the country.

What are the responsibilities of a medical center in this important area of citizen and community needs? I believe that a medical center has several important roles to play. Perhaps foremost, it is responsible for the training of health professionals, including physicians, nurses, the various allied health professions, such as dietetics, medical records, medical technology, physical therapy, radiologic technology, and hospital administrators. As knowledge in the field of medicine and allied areas has increased so greatly in recent years, specialized training has become more and more important. Medical centers have become more sophisticated, and the costs of training have increased proportionately. Another responsibility of a medical center is to assist in rendering direct service to members of a community. This includes not only the operation of its directly controlled hospitals but also assistance in rendering service in affiliated institutions.

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

My own association with the city hospital system, as well as with other hospitals, strongly supports this position. In our own St. Louis University hospitals, I mean Firmin Desloge Hospital and David P. Wohl Memorial Mental Health Institute, a considerable part of the service rendered, something over $750,000 per year, is rendered on a free or partially free basis to members of the community who would be unable otherwise to pay for the service and would, therefore, become a responsibility of hospitals supported by public funds.

A further responsibility of medical centers is the development and continuance of research studies which relate to the field of both preventive and corrective medicine. Research of the type I refer to is directly related to the teaching function, so that the health professionals will have direct contact wtih research methods and thoroughly understand 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 for more and better quality health care, all segments of the community must not only recognize the seriousness of the problem but must be prepared to cooperate in trying to solve it.

There are a number of areas in which more effective use can be made of the more highly trained professionals, such as physicians and registered nurses, and this is where our American ingenuity must be utilized. A number of people far more knowledgeable than I have suggested the development of a class of physicians' assistants, paramedics, trained as the hospital corpsmen have been trained by our Armed Forces. These could, under proper guidance, serve to meet many of the needs of the population, thus reserving for the more experienced physicians and nurses service for which their more intensive training has prepared them.

I am informed that some headway has been made in this matter, particularly at Queen's Medical Center in Honolulu. One, the operating room technician program covers a 6-month period which prepares high school graduates to work in the operating room under the direct supervision of the surgeon or a registered nurse. The second program is intended to establish a group of nonprofessional surgical assistants to supplement or substitute for surgical residents or interns in most types of surgery. Applicants for this latter program-trained surgical assistant program-must have had prior training as a military corpsman or must have completed a certified operating room technician

course.

These are only a few of the areas in which additional experience can be given people who can be very helpful in delivering health

care.

Increased emphasis on the advantages of group practice also offers an opportunity for better utilization of our present health professionals. These are but a few of the areas that must be carefully and objectively explored if we are to meet ever-increasing needs of the consumer population.

In closing, may I again thank you for this opportunity to testify before this committee. Hearings such as you are having here today encourage me in my conviction that the problems facing all of us are not only capable of solution but are receiving careful consideration and study.

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

Thank you.

Senator 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 have completed your statements, and then address the question to the group, and the individual most qualified to answer can come forth with the answer.

Several months ago, when we were planning these hearings, we contacted Father Reinert to see if we could utilize his facilities for the hearings. He said, of course we could, for a slight charge. He is known sometimes among nonclerics as Parsimonious Paul. Then when the $9.5 million grant came through, he called back and said, in light of that and you will appreciate it as an accountant, Mr. Jacksonhe thought that was adequate compensation.

(The prepared statement of Mr. Jackson follows:)

TESTIMONY OF

BEN F. JACKSON

MEMBER, EXECUTIVE COMMITTEE

BOARD OF TRUSTEES

SAINT LOUIS UNIVERSITY

Presented before

The Health Subcommittee

of

The Committee on Labor and Public Welfare

of the

United States Senate

Meeting in St. Louis, Missouri

September 2, 1970

Mr. Chairman and Members of the Committee:

My name is Ben F. Jackson. I am a retired partner of the public accounting

firm of Price Waterhouse & Co., with whom I was associated for approximately

thirty-five years. Currently I am a member of the executive committee of the Board of Trustees of Saint Louis University and Chairman of the Standing Committee for the Medical Center of that University.

My interest in the field of health and hospitals has covered a period of over twenty-five years. I have served on the Board of Directors of several community hospitals. I am also Chairman of the Joint Board of Health and Hospitals for the city of St. Louis.

I have served as Chairman of the Budget Committee of the United Fund of Greater St. Louis, as President of the Hospital Planning Commission of Metropolitan St. Louis (now ARCH) and on the Boards of several other agencies related to the general health field. I am also serving as a member of the Regional Advisory Committee of the BiState Regional Medical Program and as Chairman of the Committee on Communications and Public Relations.

I deeply appreciate the opportunity afforded me and these other witnesses

to appear

before you to discuss the subject of education for the health professions

and several of the problems related thereto.

It has become increasingly evident that the need and demand for more and better health services has spread throughout the entire country. In the past different segments of the population have been served on different bases related partly to their ability to pay for the health services they believed they needed and partly on their

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