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Reinert, Paul C., S.J., president, St. Louis University..

Robinson, Hamilton B. G., D.D.S., dean, University of Missouri-Kansas
City School of Dentistry-

Prepared statement..

Rodgers, Samuel U., M.D., director, Wayne Miner Neighborhood Health
Center; Mrs. Pauline Smith, president of the Adivsory Board, Wayne
Miner Neighborhood Health Center; and James I. Threatt, director,
Model Cities Program, Kansas City, Mo.

Prepared statements..

Page

23

478

483

385

387, 467

148

Scruggs, Karen, second-year medical student, Washington University.
Smith, Mrs. Pauline, Chairman of Advisory Board of Wayne Miner
Neighborhood Health Center, prepared statement...

Smull, Ned W., M.D., director and chairman of pediatrics, Children's
Mercy Hospital, on behalf of Herman R. Sutherland, president, central
governing board of Children's Mercy Hospital, Kansas City, Mo..

Prepared statement___

476

239

240

Smull, Ned W., M.D., president, Health Resources Institute, Kansas City,
Mo..

511

Prepared statement..

513

Stark, Nathan J., immediate past chairman of the Board of Trustees,
Kansas City General Hospital; Group Vice President, Operations,
Hallmark Cards, Inc..

233

Stoneman, William III, M.D., program coordinator bistate regional medical program, prepared statement.

191

Strickland, William A., Jr., Ph. D., dean, School of Pharmacy, University of Missouri-Kansas City..

335

Symington, Hon. James W., a Representative in Congress from the State of Missouri....

Prepared statement_.

Symington, Hon. Stuart, a U.S. Senator from the State of Missouri..
Thompson, Morris, President, Kirksville College of Osteopathy and
Surgery, Kansas City, Mo, prepared statement__

Threatt, James I., director, Model Cities program, Kansas City, Mo.,
prepared statement--

Twin, Edward J., M.D., executive director, Kansas City General Hospital.
Prepared statement, with accompanying illustrations.--
Wadsworth, Homer C., president, Kansas City Association of Trustees and
Foundations.

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Wagner, Myron, Ph. D., chairman, Department of Chemistry, University of Missouri-Kansas City..

336

Whittico, James M., M.D., past president, National Medical Association
Prepared statement.

135

140

Wilkinson, Charles B., M.D., executive director, Greater Kansas City
Mental Health Foundation____

571

Yeckel, George H., president, Kansas City Area Hospital Association and executive director, Menorah Medical Center..

489

Prepared statement..

494

ADDITIONAL INFORMATION

Articles, publications, et cetera:

"A Good Alternative to National Health Insurance," from Resident and Staff Physician, August 1970.

125

"A New Approach to Medical Education," by E. Grey Dimond, M.D., July 1961

277

"American College Physicians Participate in the Volunteer Physicians Program for Vietnam," by Hal T. Wilson, F.A.C.P., from the Bulletin, August 1970.

130

119

"Hospital Association Authorizes Addition of Director of Planning".
"It's Time to Negotiate A Medicare Fee Schedule," by Daniel F.
Crowley, M.D., General and thoracic surgeon, Des Moines, Iowa,
from Medical Economics, May 25, 1970..
"Medicine and Money," reported by Paul Friedman and filmed by
Gene Broda, from NBC News Presents 'First Tuesday,' May 5, 1970.
"Opening Medical Education," by E. Grey Dimond, M.D., con-
sultant to the chancellor for Health Affairs and distinguished
professor of medicine, University of Missouri-Kansas City, Kansas
City, Mo..

126

52

272

Articles, publications, et cetera-Continued

"Optometric Manpower in Missouri," by Gordon G. Health, O.D.,
Ph. D...
"Organized Premedical Education," by E. Grey Dimond, M.D.,
F.A.C.P., La Jolla and San Diego, Calif., reprinted from Annals
of Internal Medicine, June 1968 -

"70 Model Cities, "by James I. Threat, director, Model Cities
program, Kansas City, Mo....

"Summary of National Manpower Requirements," by Gordon G.
Heath, O.D., Ph. D., for the Missouri Commission on Higher Edu-
cation, from Optometric Manpower in Missouri, June 1970...
"The Future of Medicine in the United States," by E. Grey Dimond,
M.D., Washington, D.C., reprinted from the Transactions Ameri-
can Academy of Ophthalmology and Otolaryngology, January-
February 1969.......

"The Hospital Conglomerate and Health Care," by Ned W. Smull,
M.D., director and chairman of pediatrics, Children's Mercy
Hospital, Kansas City, Mo----

Page

573

263

389

162

266

240

"The President's Page," excerpts from selected issues of St. Louis Medicine, 1970___.

120

Communications to:

Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri, from:

Joseph C. Edwards, M.D., president, St. Louis Medical Society,
St. Louis, Mo., September 2, 1970_.

108

513

Smull, Ned W., M.D., President, Health Resources Institute,
Kansas City, Mo., September 4, 1970, with attachment_ _ _

Resolutions:

Resolution on Neighborhood Health Care by House of Delegates of
the Missouri State Medical Association____.

Resolution on Physician's Assistant Programs, by the Missouri State
Medical Association House of Delegates..

Articles, publications, etc. :

APPENDIX

"A Proposal for the Establishment of a Pediatric Nurse Practitioner (P.N.P.) Training Program," by Lawrence Kahn, division of health care research, Washington University School of Medicine, St. Louis, Mo

"Optometric Manpower in Missouri," by Gordon G. Heath, O.D., Ph. D., June 1970-

"Planning To Improve Medical School Trainees," by A. J. Reiches, M.D., and Richard L. Reiches, B.A., St. Louis (Clayton), Mo-----"Private Vocational Schools-Their Emerging Role in Postsecondary Education," staff paper by A. Harvey Belitsky, the W. E. Upjohn Institute for Employment Research, Kalamazoo, Mich., June 1970__ "There Is A Doctor Shortage in Missouri But-The Missouri Osteopathic Profession Is Doing Something About It," published by the Missouri Association of Osteopathic Physicians and Surgeons, E. H. Borman, executive secretary-treasurer, Jefferson City, Mo Communications to:

Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri,
from:

Borman, E. H., executive secretary-treasurer, Missouri Associa-
tion of Osteopathic Physicians and Surgeons, Jefferson City,
Mo., with enclosure, September 10, 1970___.
Bridges, George H., Jr., Ph.D., State supervisor, health occupa-
tions, division of vocational education, Kansas State Depart-
ment of Education, October 2, 1970---

124

118

681

578

738

703

695

693

659

751

Driscoll, Glen R., chancellor, University of Missouri, St. Louis,
Mo., September 14, 1970, with enclosure_.
Gress, Lucille, assistant professor, School of Medicine, department
of nursing education. University of Kansas Medical Center,
October 15, 1970, with attachment----

662

Kahn, Lawrence I., M.D., division of health care research, Wash-
ington University, School of Medicine, St. Louis, Mo., August
18, 1970-

670

Communications-Continued

Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri, from-Continued

Page

Rabe, Charles C., president, St. Louis College of Pharmacy, St.
Louis, Mo., September 10, 1970----

750

667

Wicks, Edwin O., M.D., Dr. P.H., Director of Health, City of Kan-
sas City, Mo., September 23, 1970---
Finch, Mr. Robert, Executive Assistant to the President, The White
House, 1600 Pennsylvania Avenue, Washington, D.C., from A. J.
Reiches, M.D., and Richard L. Reiches, B.A., St. Louis (Clayton),
Mo., August 14, 1970_____

Labor and Public Welfare Committee, U.S. Senate, Washington, D.C.,
attention: Jim Murphy, from Samuel L. Gilberg, A.B., D.D.S.,
chairman, Missouri Association Trade and Technical Schools, St.
Louis, Mo., September 8, 1970, with enclosure__.

740

701

Mayer, R., dean, University of Missouri Medical School, Columbia, Mo.,
from A. J. Reiches, M.D., and Richard L. Reiches, B.A., St. Louis
(Clayton), Mo., April 15, 1970----
Murphy, James, New Senate Office Building, Washington, D.C., from
Stanley Reitman, M.D., medical director, Gradwohl School of Labora-
tory Technique, St. Louis, Mo., September 15, 1970_--
Reiches, A. J., M.D., St. Louis (Clayton), Mo., from:

749

661

Danforth, William H., M.D., vice chancellor for medical affairs,
School of Medicine, Washington University, St. Louis, Mo.,
March 12, 1969---.

746

Ebert, Robert H., M.D., dean, Harvard Medical School, Boston,
Mass., June 13, 1968-

744

Felix, R. H., M.D., dean, School of Medicine, St. Louis Univer-
sity, St. Louis, Mo., July 8, 1968--

748

Howard, Robert B., M.D., dean. College of Medical Sciences, Uni-
versity of Minnesota, March 19, 1970_.

745

Moore, Carl V., M.D., Department of Internal Medicine, Barnes
and Wohl Hospitals, School of Medicine, Washington University,
St. Louis, Mo., June 25, 1968--

747

Nicholson, Hayden C., M.D., Director, American Medical Associa-
tion, Chicago, Ill., January 20, 1969--

742

Prepared statements:

American Academy of Pediatrics, Evanston, Ill.
Black Student at St. Louis University Medical School--
D'Entremont, Richard A., Sophomore, St. Louis School of Medicine---
Driscoll, Dr. Glen R., chancellor, University of Missouri, St. Louis, Mo.
Green, Daniel, St. Louis University---

672

654

649

752

652

Gress, Lucille, R.N., assistant professor, University of Kansas School
of Medicine, Department of Nursing Education___
Washington University School of Medicine, the department of pedia-
trics and the division of health care research, St. Louis, Mo----

663

677

HEALTH MANPOWER

WEDNESDAY, SEPTEMBER 2, 1970

U.S. SENATE,

SUBCOMMITTEE ON HEALTH

OF THE LABOR AND PUBLIC WELFARE COMMITTEE,

St. Louis, Mo.

The subcommittee met, pursuant to call, at 10 a.m., in Miller Hall, Firmin Desloge Hospital, Senator Thomas F. Eagleton of Missouri (chairman) presiding.

Present: Senator Eagleton of Missouri.

Also present: Senator Symington and Congressman Symington. Staff members present: James J. Murphy, subcommittee counsel; Loren Walters, subcommittee research assistant; and Edward L. Filippine, staff assistant.

Senator EAGLETON. Good morning, ladies and gentlemen.

This meeting of the Senate Subcommittee on Health of the Senate Labor and Public Welfare Committee will now be in session.

Prior to making what I hope will be a rather brief opening statement, I would like to dispose of some, shall we say, housekeeping

chores.

First I want to introduce and have identified, for the record, those who will be assisting me in this hearing in St. Louis this morning, as well as one in Kansas City later this week.

To my right, Mr. James J. Murphy, counsel to the subcommittee; next to Mr. Murphy, Mr. Loren Walters, research assistant for the subcommittee; the other gentleman who was to my left a minute or two ago is my assistant here in St. Louis, Mr. Edward Filippine.

Also let me say at this juncture-and I will repeat it at the noon hour and also at the conclusion of the hearing-that any individuals who, because of the limits of time or the inadequacy of the amount of notice given for these hearings, wish to submit a statement to be put in as part of the record may do so if they will submit such statement to us in writing within the next 2 weeks.

Stated another way, the record of this hearing here in St. Louis will be held open for supplemental statements, statistics, appendixes, and the like for 2 weeks.

I would now like to make an opening statement to set the background for today's hearing.

Frequently we hear it said that there is a crisis in health care in this country. By definition a crisis is a turning point; things are either going to improve or they will deteriorate. In short, it is a point at which change of some type is inevitable.

The course of change in health care will be greatly affected by Federal legislation in this area. Many concerned individuals have

voiced suggestions for the restructuring of existing Federal medical programs, medicare, medicaid, the Health Professions Education Assistance Act, and so forth. Most recently, Senator Edward Kennedy and 14 other Senators introduced a far-reaching proposal for a national health insurance system.

The Kennedy bill is one of the most sweeping, thoroughly researched programs for improving health care we have seen. It addresses itself not only to the question of financing adequate care for all of us, but also to correcting many of the inefficiencies which plague our present system for delivering health care.

The Kennedy proposal will undoubtedly be hotly debated in months and years to come. Its enactment is by no means a certainty. What is certain is that our health care system will not stand still while this bill is being considered.

It is equally certain that the most ingenious plan, the most elaborate mechanism, the most refined blueprint will be of little value without an adequate supply of trained health manpower to implement it. There will be no significant improvement-indeed, deterioration is the more likely prospect-if we fail to increase the numbers of health personnel in the United States. This is doubly true if any existing educational institution for the health professions should be forced to close for lack of funds.

Today's hearings are designed to focus attention on the manpower problem and to obtain information relating to it.

Despite some differences among the experts, there is general agreement that we need something in the neighborhood of 50,000 doctors and 9,000 dentists. It is impossible to document the need for allied health personnel since, as yet, we have not even established the possible scope of their use.

How are we going to begin to meet these reeds? How much Government assistance is going to be required and, perhaps of even greater importance, what kind of assistance should that be? What is the proper role for all levels of government, local and State, as well as Federal?

Will graduating more doctors, dentists, nurses, and other personnel answer the problem, or must we also examine the manner in which their services will be employed? What should we do to alter the distribution of these trained people so that not only Clayton and Webster Groves, but also the inner city and rural Missouri can receive the advantages of better health care?

What is the value to the community of a medical center, with all of its related institutions, and what should be the role of the medical center in promoting improvements in the delivery of health care?

How do we induce doctors to better utilize their time and talent by making use of the services of paramedical personnel to handle those procedures within the competence of subprofessionals that now consume so much of the doctor's time?

Health manpower-numbers, distribution, better utilization-that is our subject for today.

I repeat, this is a subject of national importance-the indispensable prerequisite to any health care program, private or public.

As our first witness this morning, I am pleased to call on my senior colleague in the U.S. Senate, a native of the St. Louis area and a man

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