understanding of their need for various health services both preventive and corrective. Many of our citizens unfortunately have been either 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 in addition 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. Saint Louis University Medical Center has affiliations with the following institutions - 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 Saint Louis University Hospitals (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 partial 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 fields of both preventive and corrective medicine. Research of the type I refer to is related directly to the teaching functions so that the health professionals will have direct contact with research methods and thoroughly understand their importance.

Saint 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 have, I believe, 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, and 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 towards a solution in the near future the situation will become more critical in the decade ahead. This is one of the principle reasons why I appreciate the opportunity you have afforded me to testify today before your subcommittee. A hearing such as this one indicates that the problem is receiving increased attention.

How can we meet the financial demands? The recent grant from the Department of Health, Education and Welfare 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 this 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 Saint Louis University a student paying full tuition at the present time pays approximately 1/5 of that amount; the remainder must be derived from other sources. We have a very modest endowment, the income from which covers less than 1/10 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.

If we in this country are to continue to try 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 corpmen 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 services for which theirmore 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 Operating Room Technician program covers a six month period which prepares high school graduates to work in the operating room under the direct supervision of a surgeon or a registered nurse. The second program is intended to establish a group of non-professional 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.

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 the ever increasing needs of our 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 you have, I will attempt to answer them.