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formulated to insure against abuse or waste of government funds.

Availability

Although not accessible to many, we have an adequate number of educational institutions offering baccalaureate programs in the allied health services to meet projected demands for personnel, if these programs were properly coordinated and if resources in terms of space, faculty and equipment were properly exploited. Many colleges and universities including Saint Louis University, given financial assistance to expand faculty, laboratories and space, could substantially increase their enrollment. In 1969, one-hundred and eighty-six students were enrolled in the five allied health programs offered by the School of Nursing and Allied Health Professions of Saint Louis University. This represented a slight increase (6%) from the previous year. A similar increase is anticipated for the coming school year.

If justified by an increased demand that could be generated by expanding the traineeship program, an additional fifty students could be accepted with the employment of five full time faculty members and an increase of 15,000 square feet of laboratory and classroom space.

Thirty-five years ago Saint Louis University became the first college or university in the United States to sponsor a school that included a baccalaureate program for nurses and four allied health programs. A private university, it is not accessible to many because of necessary tuition charges. Located in an area that offers unlimited potential in terms of clinical facilities, expansion and experimentation have been impeded by lack of funds.

Preparation

The degree of preparation for each of the identifiable allied health profesfor some a two-year program may be adequate; others require more intensive preparation, involving not only the acquisition of technical skills,

sions varies

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but a knowledge of subjective influence of illness and its impact upon a given personality. The teacher, administrator, researcher and the technologist specialist require training beyond the baccalaureate level and it is in this area our greatest shortage will exist.

In common with medicine and nursing, allied health professionals - in the course of their preparation must be exposed to patient contact in actual work

situations under supervision of competent faculty. Faculty supervision must be on a personal basis, both in the laboratory and in the care of patients; consequently the ratio of faculty to students requires maintenance of a large teaching staff

with attendant expense.

This desirable educational experience can best be offered in a university medical center complex whose resources include a medical school, hospitals and a school of nursing and allied health professions with access to a full range of related disciplines, i.e., education, basic sciences, administration, etc., where the administrative structure with its coordinating processes are in existence. Government Assistance

but

The allied health programs at Saint Louis University and in other schools with similar programs would be severely handicapped or perhaps discontinued if assistance in the form of basic improvement grants were not made available over the past five years. I would encourage this committee to strongly support legislation continuing this form of assistance in an increased amount and with less rigid requirements for annual increase in enrollment.

As with all programs designed to meet a growing need, there exists the danger of over proliferation. New and innovative programs should be encouraged but it is conceivable that we will so fragment our delivery of health care with specialists that manpower in terms of efficiency and effectiveness will be dissipated. needs of the public might best be served by exploring the feasibility of preparing

The

health personnel with capabilities in more than one area, rather than encouraging the continued development of technicians and/or technologists with expertise in but one specialty. The majority of our hospitals are small; the majority of consumers live in areas that cannot support, in terms of demand, the many specialties that exist.

Research on the contribution of each specialty, evaluated in terms of developing technology and feasibility of application, should be conducted by a selected number of institutions with the resources to conduct such a study. To meet the needs of various sections of the country, perhaps more than one such program could be subsidized to work with curriculum development, evolution of new programs and experimentation with existing programs.

Perhaps one example of the need for such research is the emergence of the Physician's Assistant. The concept is valid; the terminology may be unfortunate. Several programs designed to prepare personnel qualified to assume routine responsibilities of the physician have been initiated, but objectives and standards seem to lack uniformity.

For the protection of consumers and the medical profession, the role of the Physician's Assistant must be clearly defined. As a consumer, I would expect

a person with the title of Physician's Assistant to have a basic orientation to

health care.

Thank you.

This orientation can best be provided in a medical center complex.

Senator EAGLETON. We now have Dr. Oliver Duggins, Ph. D. It is refreshing to have a Ph. D. with us, after all of the M.D.'s. He is chairman of the Life Sciences Division, Forest Park Community College.

STATEMENT OF OLIVER H. DUGGINS, PH. D., CHAIRMAN, LIFE SCIENCES DIVISION, FOREST PARK COMMUNITY COLLEGE

Dr. DUGGINS, Dr. Cosand apologizes for having to leave. Senator EAGLETON. Yes, I would like the record to show he was with us for 2 or 3 hours waiting very patiently, and I know what his schedule problems are.

Dr. DUGGINS. He has asked that I represent him, and we appreciate this opportunity.

I'd like to make four or five very rapid comments on things that have been said so far.

I think probably the community colleges are in better position, or as good a position, as any other institution or type of institution to supply allied health personnel, and there are three or four reasons

for this.

First of all, 42 percent of all the students who are in colleges today are in community colleges. The Junior College District of St. Louis in its very short existence is already the second largest college in the State of Missouri, and we anticipate or estimate that 60 percent of all students in college by 1975 will be in community colleges.

Secondly, community colleges are open-door colleges. We feel committed to meeting the needs of each individual student, as well as meeting the needs of the community.

Senator EAGLETON. Your open-door colleges are subject to the limits financially, aren't they?

Dr. DUGGINS. Well, we haven't been limited yet.

Senator EAGLETON. Federal City College, for instance, in Washington, D.C., yesterday turned down 2,500 students.

Dr. DUGGINS. We may have to do this; we haven't yet.
Senator EAGLETON. It is a real tragedy.

Dr. DUGGINS. Thirdly, technical or career training is one of the major emphases of the community college.

Fourthly, there are over 200 allied health programs, and most of these can be offered in 1 or 2 years which, of course, is the specialty of the community college.

The Junior College District of St. Louis at the present time has more than 600 students enrolled in allied health programs. There are eight allied health programs we are presently offering.

Senator EAGLETON. Would you supply for the record at a later date, Doctor, the titles of the programs, a brief description as to the type of training that provides, and the number of students enrolled in each?

Dr. DUGGINS. All right. I might just say that these are in eight programs and we have them listed here [indicating].

Senator EAGLETON. Oh.

Dr. DUGGINS. There are 34 in clinical lab technology, 74 in dental hygiene

Senator EAGLETON. That's all right. That will be in the record. I'm

sorry.

Could these programs, if you had greater demand, could you handle-I see you have 74 in dental hygiene, but could you handle 84? Dr. DUGGINS. Only with additional faculty, and we don't have the funds for it.

Senator EAGLETON. Are you at the breaking point, the point of no return, on all of these programs, that is, you just can't take any more into any of these programs?

Dr. DUGGINS. Not quite, no; we are approaching it. I think the figure that you brought out this morning might be clarified a little bit. You said, I think, that there were 28,000 vacancies or openings in a certain number of programs, but only 10,000 graduates.

Senator EAGLETON. Yes, here [indicating] it is. This is from the AMA.

Dr. DUGGINS. The reason for this, I think, is that probably most of those programs are running at capacity, but you don't graduate the number of students that you have in the program because of your attrition rate. So, even though

Senator EAGLETON. I will clarify it, then. This is from the AMA, September 15, 1969, the total student capacity, and I read the job titles earlier-28,308 student capacity, enrollment 20,495, graduates 10,079, still it leaves 8,000 vacancies according to these statistics. But you are pretty much at the top level.

Dr. DUGGINS. Four of our programs are oversaturated, we are beyond capacity. Nursing is over capacity. We have a waiting list of 275.

Senator EAGLETON. In operating a junior college, your vocationaltechnical programs, per student, are more expensive than straight liberal arts, usually speaking; isn't that the case?

Dr. DUGGINS. Right. I pointed out here to train a nurse it takes $51.58 in our institution per credit hour, plus the expensive equipment and professional personnel. We can train four liberal arts students for the same amount. Therefore, we are in competition with the liberal arts programs for the limited budget dollar.

I personally feel that it is well worth the expense and that we probably can train this person as economically or more economically than anyone else, but still it is expensive and, of course, we have problems meeting our budget, too.

do

Senator EAGLETON. Of these 600 students enrolled in these programs, you have an estimate as to how many of them are black?

Dr. DUGGINS. I can tell you on the Forest Park campus, this is a very difficult figure to come by, because we keep no records of this type. I went back and spent a lot of time just looking it up in preparation for this, however. We have taken in 100 freshmen in our nursing class for the Fall, and 57 are black. More than this would be of minority groups, Philippino, Indian, and so on, but 57 we can identify as being black.

We have taken in 27 at Forest Park in X-ray, 14 of whom are black. We have taken in 17 in clinical lab in our freshmen class, seven of these being black, and so on. The percentage is going up. We had the same difficulty that you mentioned before. In the first year or two we had difficulty in attracting black students into our program, but it is catching on now and we are getting more and more applicants from this group. We feel very much obligated to meet this

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