recruitment teams designed to find, motivate, and bring low-income persons into the dental profession. This should be a joint effort between the university, the inner city dentists, and the high school counselors.

We will probably never see the day when there are enough Physicians, Dentists, Pharmacists, etc. in the inner city again as solo practitioners. Most black Physicians are forming groups and moving their offices to or near the affluent blacks, leaving the poor to find ways of reaching them.

Certainly financial incentives could make it profitable for physicians and others to remain in the ghetto except for the fact that that Medicaid in this State is so bad we probably would still have some in these areas. If we had an adequate Medicaid program in this State, we could probably attract black group practices into poor areas of our City. If such a group was formed, I feel that federal construction loans should be available to these groups because loans and insurances are almost impossible to secure at the local level.

This type of loan has been made available in East St. Louis, Illinois, and could become a reality in St. Louis.

For too long the AMA and the ADA have worked more to protect the interests of the doctor than to maintain the high level of health care that is needed in our nation. Now, social pressures are becoming more intense and unless something is done to relieve that pressure both the doctors and their patients may suffer irreparable harm. Therefore, the federal government, organized medicine and dentistry, and the university must greatly increase their concern and sense of responsibility. They must acquaint themselves with same vital questions being raised about the

health care mission and the ways in which society might want that mission

modified.

Senator EAGLETON. We now have Dr. Sam Pagano, D.D.S., president, Greater St. Louis Dental Society, and Dr. Russell Buchert, D.D.S., president, Missouri Dental Association.

STATEMENT OF SAM PAGANO, D.D.S., PRESIDENT, GREATER ST. LOUIS DENTAL SOCIETY, AND DR. RUSSELL BUCHERT, D.D.S., PRESIDENT, MISSOURI DENTAL ASSOCIATION

Dr. PAGANO. Mr. Chairman, I would like to thank you for the opportunity of being here this afternoon. I would like to point out some observations made here this morning.

It seems that most of the emphasis has been placed on medical schools and medicine. Total health care demands adequate dental care. We need more trained doctors of dental surgery. Congressman Symington's statement this morning was very true when he said you don't meet the needs of people when you close schools. The closing of St. Louis University Dental School is indeed felt in the St. Louis area and this loss will continue to get worse.

All new federally supported and proposed health care legislation seems to ignore or offer only a minimal amount of dental care for the U.S. population. I ask the question, why is this so when we know that dental care is the most prevalent disease in America today.

The impact of the United Auto Workers requesting dental care for themselves and their families will place a new and larger demand on departmental manpower in the St. Louis area. This is in addition to the already existing McDonnell-Douglas insurance plan which has created a new segment of the population requiring dental care. This is also in addition to the paramount needs of the medically indigent. To me, from most of the preceding statements, dentistry and dental care seems to be a voice in the wilderness. We are alluded to but faintly not heard. True, you do not die from a toothache, it is not dramatic to be a dental cripple. One of our eminent Presidents, Franklin Delano Roosevelt, was a cripple with polio. Had he been a dental cripple of equal magnitude he would never have been elected, because his speech and appearance would have been impaired. Yet, dental decay can be prevented, restoration of dental cripples can be effected, and good oral health for the population can occur, but this occurrence cannot take place if we ignore the acute problems facing the profession of dentistry in providing dental care for the American populace.

In conclusion, I would like to ask that dentistry be included completely in your definition of total health care.

Senator EAGLETON. Fine, Doctor. Thank you.

For the record, of all institutional Federal grants given last year, 56 percent went for medicine, 22 percent went for dentistry, and there are approximately, although I don't have exact figures, twice as many medical schools in the country as dental schools. Do you have the exact figures on how many dental schools in the country?

Dr. PAGANO. Fifty altogether.

Senator EAGLETON. How many medical schools in the country?
Father DRUMMOND. 101.

Senator EAGLETON. Dr. Buchert.

Dr. BUCHERT. Senator, I would like to thank you for extending this invitation to me as president of the Missouri Dental Association. I

want to point out several things. Unfortunately, we will not receive any more additions to our dental manpower from St. Louis University School of Dentistry. In the past 5 years there were a total of 245 graduates of the dental school. This is from 1965 to 1969. Of that total, 49 were Missouri residents, or 20 percent. Those that graduated, 74.69 percent, or a total of 183, were licensed to practice in Missouri, which means that we had 20 percent residents coming into the dental school, and possibly we retained that 20 percent and picked up another 54 percent who stayed in this area to practice. We will lose that from here on out, that is, approximately 65 dentists every year.

Senator EAGLETON. I have heard so many statistics. Do you recall what Dr. Bensinger said insofar as how much of that slack Washington University could possibly pick up?

Dr. BUCHERT. I do not recall.

Senator EAGLETON. It will be in the record.

Dr. BUCHERT. I think about four or five students a year.

Senator EAGLETON. So a net loss of 61. Was that an annual-what was this year's graduating class, this being the last at St. Louis University?

Dr. BUCHERT. I have heard for 1969, 50. There were 60 in 1970. I do not have the figures for this year for the simple reason that the Missouri board was just given about 2 months ago and this information is not available at this time.

We have heard an awful lot about the medical profession becoming community oriented. For some reason or other we forget that dentists are a part of this medical community. The activities of any dental school are closely interrelated with community life, primarily because of patient treatment aspects of the educational program and because of minimal fees assessed for clinical treatment. High quality professional care is thus made available to many individuals from the lower income levels to whom treatment might otherwise be denied because of limited public health facilities within the community.

Although primarily a teaching institution, and not oriented to treatment as its primary goal, St. Louis University School of Dentistry for many years has played a major role in providing dental health care for the St. Louis metropolitan area. There are a number of facilities in this area which will be lacking in dental manpower because of the closing of the school. The private practitioner cannot possibly pick up this slack. We're certainly not going to graduate enough students to staff these programs.

It's amazing to me that the previous witness who gave us the figures on the Yeatman Center, where there were six white dentists serving in that Yeatman Center. I was of the opinion that there was one dentist, and he was a black orthodontist, so apparently the white dentists are working with the community program.

Senator EAGLETON. Well, at the Yeatman Center-is Mr. Henley still with us?

How many white dentists are practicing dentistry in North St. Louis other than at the Yeatman Center?

He's gone. My suspicion is zero. Do you suspect otherwise?

Dr. BUCHERT. I don't know. I don't even know who the individuals are, unfortunately. I wish I did.

Senator EAGLETON. Washington University has a dental school and there is one at Kansas City operated by the State.

Dr. BUCHERT. Right.

Senator EAGLETON. Do you know how many black students are currently enrolled in Washington University Dental School?

Dr. BUCHERT. I do not know, sir.

Senator EAGLETON. Do you know how many are enrolled at Kansas City Medical School?

Dr. BUCHERT. I do not have those figures.

Senator EAGLETON. Do you find that the trend in dental area of medicine is pretty much as in the physician area, that black physicians, it has been said, tend to minister to the needs of black patients; black dentists would tend to minister, I guess, to the needs of black patients likewise?

Dr. PAGANO. Yes.

Dr. BUCHERT. I think this is true in large communities. As you get out into the outstate areas, then you find that the white physician and white dentist is treating both black and white.

Senator EAGLETON. I take it that's the case. I don't know of any black dentist or orthodontist practicing in Sikeston, for instance. Dr. BUCHERT. No; but I point out the white physician and dentist is treating the black patient in these areas.

Senator EAGLETON. Do you think that along the lines of statements of some of the preceding physician witnesses, that a greater emphasis has to be placed in dental education on minority groups, specifically blacks, Mexican-Americans, Puerto Ricans, where they are in great abundance, for instance, in the New York area?

Dr. BUCHERT. I think this is true. I think that dental education has to be geared to all groups. This is one of the problems that we have had in the practice of dentistry in that dentistry has a very low priority in the economic want list.

Approximately 85 percent of the population seek and buy what they want, whether they need it or not. I'm not talking about the 15 percent of the 200,000-plus that are economically deprived of financial means, but there is 85 percent that buy what they want whether they need it or not, and they still have a low priority on dentistry. In other words, they do not understand the importance of good dental health care.

Health education has to be geared to all segments of the population, not just the economically deprived.

Senator EAGLETON. I think that makes sense.

Dr. BUCHERT. This is something that the American Dental Association is trying to correct.

Senator EAGLETON. Thank you, doctors. We appreciate it very much. We will now have four witnesses appearing simultaneously; Sister Mary Stephen, dean, Nursing and Health Services, St. Louis University: Dr. William Stoneman, program coordinator, bistate regional medical program; Dr. Charles Berry, associate dean, Nursing and Health Services, St. Louis University; and Dr. Oliver Duggins, chairman, Life Sciences Department, Forest Park Community College. Would Sister Mary Stephen and the three gentlemen come forward? Dr. Stoneman's area of authority goes beyond the allied health services, but his work is related and he has a deep interest therein, so we asked him to join in this four-member presentation.

Dr. Stoneman, why don't you start off?

STATEMENTS OF SISTER MARY STEPHEN NOTH, S.S.M., SCHOOL OF NURSING AND ALLIED HEALTH PROFESSIONS, ST. LOUIS UNIVERSITY; WILLIAM STONEMAN, M.D., PROGRAM COORDINATOR, BISTATE REGIONAL MEDICAL PROGRAM; CHARLES E. BERRY, A.B., M.Sc.H.A., J.D., ASSOCIATE DEAN, SCHOOL OF NURSING AND ALLIED HEALTH PROFESSIONS, ST. LOUIS UNIVERSITY; OLIVER H. DUGGINS, PH. D., CHAIRMAN, LIFE SCIENCES DIVISION, FOREST PARK COMMUNITY COLLEGE

Dr. STONEMAN. Thank you, Senator. I would like to thank the subcommittee for inviting me.

If I may, I'll try to distill and present the prepared remarks in the order in which the questions were addressed in your letter.

With respect to the question of increasing the involvement of health professional delivery service, I think my remarks have been pretty well covered in the comments that were made by witnesses who spoke to the past history of the funding mechanisms that have seemed to put research and health care delivery at odds with one another at this time. I think that the dilemma we are faced with at this point in time is, in part, a measure of the success of American medical research efforts. We are now confronted with more tools of delivery or tools for treatment of disease than it seems we can use well, and while more human resources must be directed toward solutions to this delivery problem, it should be clear that the research which deals with health care delivery ought not to be abandoned.

At the same time, as a result of departmentalization in our schools, and as a result of the strong Federal emphasis on basic research funding as a mechanism for producing changes in schools, we have developed a system which probably lures many of the most promising medical students away from clinical practice, and I think this has to be changed. The Government can't continue to stimulate, by infusion of dollars, a system which immures a great part of our human medical resources into intramural research programs which don't relate to community need.

What, then, is the responsibility and the role of the medical center? That was the next question in your letter.

The value of the medical center, particularly the university-based medical center, I think, is its great potential to mobilize its resources as an educational and service institution to assist in providing the elements we need to improve the delivery system. The medical centers have been at the core of regional medical efforts to assist the providers of health care. Now we are talking about helping a $60 billion private sector "industry" to meet the problems with which it's faced, and the resources for doing this are extremely limited. They are obviously limited to the extent that they can't impact significantly in terms of total additional dollars to pay for additional service. In relation to a $60 billion industry RMP resources are minuscule, but where regional medical programs have been effective around the country, the strong efforts of medical centers, particularly university-based medical centers, have been central to their success. Where they have been less effective, generally, one will see on examination that there is a lack of strong commitment by university medical centers.