Dr. Kiker. Doctor, it is a pleasure to have you here. I notice that you come from Gainesville, Fla., which I believe is Mr. Matthews' district. We know about Florida through Mr. Rogers here. We are happy to have you with us today.

STATEMENT OF DR. JOHN E. KIKER, JR., PROFESSOR OF CIVIL ENGINEERING, UNIVERSITY OF FLORIDA

Mr. KIKER. Thank you very much, sir. I might add that anyone who did not hear Dr. Burney at the commencement address at the University of Florida yesterday missed a very fine talk and presentation on the general public health programs and problems.

Mr. Chairman and members of the committee, I am indeed grateful for this opportunity to say something in support of the need for public health educational facilities at engineering institutions undertaking teaching and research in sanitary engineering.

I am a sanitary engineer with 34 years experience; 10 in private enterprise, 7 in State health department work, 4 in the Army Sanitary Corps during World War II, and the last 13 in teaching, as head of the Sanitary Engineering Section, Civil Engineering Department, College of Engineering, University of Florida.

When I first heard of the proposed legislation, H.R. 10341, to provide broader grants to medical, dental, and public health schools, I wrote a letter to Secretary Flemming urging that engineering schools be specifically mentioned in any legislation to provide for broader grants for health related research and training programs.

I received a courteous reply from Dr. Kenneth M. Endicott which I interpreted to indicate that departments of sanitary engineering would probably be included after the first year or two of experience in the administration of the program.

Sanitary engineering training may be obtained either in schools of public health or in schools of engineering. My main objective now is to emphasize the need for assisting the engineering schools as soon as possible. Unless this is done the pending legislation may have an adverse effect upon the main source from which sanitary engineers are now obtained because the sanitary engineering schools without grants would be placed at a disadvantage in competing with public health schools which receive grants.

The great reduction in death rates since the turn of the century have been due largely to sanitary engineering activities. Of all the disciplines involved in environmental health, I believe that none is more important than sanitary engineering or requires more of a diversification of knowledge of the more difficult of the basic sciencessuch as chemistry, physics, and mathematics-than does sanitary engineering.

This is a very broad statement and I am not unmindful of the fact that medicine would have to be regarded as an absolute necessity in any appraisal of relative importance. Nor am I unmindful of the background of science that is required by the health physicist who is engaged in radiological health programs.

In the overall picture, however, the well qualified sanitary engineer who has been properly trained for the solution of tomorrow's prob

lems in environmental health must have a rigorous background of a kind which can best be acquired through matriculation in an engineering institution that has a creditable program in sanitary engineering. However, creditable sanitary engineering programs are offered in relatively few engineering schools, and where one is offered it generally has the status of an orphan as compared with other engineering programs which are given greater support. Lacking the popular appeal of the others, it requires more outside stimulus. The addition of sanitary engineering in H.R. 6906 and H.R. 10341 should provide much of the help that is needed.

For several years, efforts have been made at the University of Florida to develop a sanitary engineering program to help provide the talent needed to keep up with the rapid technological advances which affect the environment and create new health hazards.

Particularly in the new fields of air pollution and radiological health, where needs are critical, our progress will depend largely upon the extent to which outside assistance is received.

I should like to emphasize also that progress in the actual control of environmental hazards is dependent more upon research contributions from engineering schools than from any other source, hence I would urge that engineering schools be specifically mentioned in any legislation to provide for broader grants for health related research and training programs.

That is all of the prepared statement that I finished yesterday. I did not even proofread it before I got the train from Gainesville. This morning Mr. Rogers suggested that I might submit data substantiating the need for sanitary engineers and training, and in the interim, Mr. Rogers, I called the Sanitary Engineering Resources Office in the Public Health Service and have received that information. I wonder if you would like to have it, Mr. Chairman, submitted as a part of the record?

Mr. ROBERTS. Without objection we will be glad for you to file it with your other statement.

Mr. KIKER. Thank you, sir.

(The information referred to follows:)

Graduate training needs in sanitary engineering

I. THE BACKLOG AMONG PRACTICING ENGINEERS (THOSE WHO NEED OR WOULD BENEFIT BY AT LEAST 1 YEAR OF GRADUATE TRAINING)

Backlog to be trained by 1970 (assume 585 are over age and will be replaced by trained young men)..

2,340

1,920

680

1,240

2, 385
1,800

II. ANNUAL TRAINING NEED

(a) Absorbing backlog (1100).

180

(b) To meet retirement, death and defection..

280

Allow 4 percent per year through 1970 1,820 (33.3 percent) will be over
63 by 1970. At least 0.67 percent will change profession/year.
Assume average count of 7,000 (1960-70) .04X7000=280.

(c) Due to population increase..

100

Use of ratio of 32 per million population; say 25/million need graduate training; at 4 million increase/year=4X25=100.

Mr. ROBERTS. Thank you, Doctor.

Are there any questions, gentlemen?

Mr. ROGERS of Florida. Mr. Chairman, I just wanted to say that we are delighted to have Dr. Kiker here. I know of the fine work he is

doing in the University of Florida and I think he has made a very significant suggestion here. I am very anxious to see his figures and hope that the committee, as I am sure it will, will consider them in this legislation.

Mr. KIKER. Thank you very much.

Mr. ROBERTS. Thank you, Doctor.

I have a statement I would like to put in the record from Dr. Nelson of the American Hospital Association.

(The statement referred to follows:)

STATEMENT OF THE AMERICAN HOSPITAL ASSOCIATION PRESENTED BY

RUSSELL A. NELSON, M.D.

Mr. Chairman, I am Dr. Russell A. Nelson of Baltimore, Md. I am the director of the Johns Hopkins Hospital and president of the American Hospital Association. I appear today on behalf of the association.

The American Hospital Association is a voluntary, nonprofit membership organization with about 7,000 members, including the great majority of all types of hospitals. The hospital members provide over 90 percent of the Nation's general hospital beds. Last year, over 23 million people were admitted as patients into our hospitals-about 1 in 8 of our population. Each year, more and more of the public seek care in a hospital. Our primary interest-and the reason for

the organization of this association-is to promote the public welfare through the development of better hospital care for all the people.

In order to improve knowledge of disease and to meet the growing need for more and better doctors to practice in our hospitals, the American Hospital Association has for a number of years supported proposals for Federal grants to assist in the construction not only of educational and research facilities but also of teaching facilities for the Nation's medical schools. This support has been set forth in statements presented to this committee. I reiterate the conclusion reached in a satement submitted in 1958:

"We hope, herefore, that this committee and the Congress will take favorable action on legislation authorizing grants for medical school facilities to assist in providing adequate numbers of well-trained physicians to serve the American people."

This association is deeply concerned with the quantity and quality of medical education. A considerable number of hospitals are a part of or are affiliated with medical schools. Altogether, 859 hospitals offer internships and 1,298 hospitals offer medical and surgical residency training programs. A good many of these hospitals are also engaged in programs of continuing education for medical practitioners. In large part, the programs of medical research supported by the Federal Government and private sources are conducted in these hospitals.

Of primary importance to the public, if it is to benefit from the results of medical research, is the translation of the research into methods and procedures for patient care. The hospitals I speak of are responsible in large part for the adaptions which make research meaningful to the people. The hospitals and the schools must be able to get the best in facilities and equipment to do this job.

Buildings, beds, and laboratories are not enough, in fact not even the most important factor. The quality and competence of the doctors-and enough of them-is a No. 1 point. This depends upon the quality and availability of medical education in our country.

At the present time, a good many of the medical schools and their teaching hospitals are housed in poor and inadequate buildings. These older schools have a major need for renovation and modernization of existing facilities or for their replacement. A study by the Association of American Medical Colleges indicated that, if the existing medical schools were able to carry out required construction, as well as to renovate and modernize their facilities, they would be able to increase their enrollment by 1,060 students.

There have been a number of studies with documentation as to the availability of physicians and the needs of the country. The staff report, "Medical School Inquiry," presented to the House Interstate and Foreign Commerce Committee in 1957, made an important contribution to the information needed on this sub

ject. The report, "Physicians For a Growing America," published in October of 1959, provides an excellent statement as to the availability of physicians, the need for physicians, and details pertaining to medical schools and their problems. I shall not attempt to repeat the evidence set forth in these reports. I wish to note simply that the report, “Physicians for a Growing America,” and the more recent report on Federal Support of Medical Research, developed for the Senate Appropriations Subcommittee, agree that in view of the expanding population, and the complexity of medicine, the United States has an increasing need for medical services and faces a growing shortage of physicians. We agree with this conclusion.

The pattern of medical education and practice in recent years has changed with the growth in hospital residency and internship programs. Almost every physician now graduating from medical school serves an internship. Many accept residencies or fellowships. Prior to World War II, hospitals offered a total of 13,000 approved internships and residencies and, at the present time, there are more than 30,000 internships and residences available in hospitals. These figures represent a change in the preparation of physicians and the growth of specialization. The physician preparing for a speciality is required to take a. residence program of from 3 to 5 years or more before he is eligible to take his specialty board examinations.

I emphasize this as it indicates the increased role of the hospital in the education of physicians and shows that continuation of high quality specialist training will require teaching facilities in our hospitals.

Hospitals are unable to fill a substantial percentage of the available internships and residencies and it is estimated that 1 out of every 4 of such positions remains vacant. To an increasing extent, many hospitals have provided internresident appointments to physicians who are graduates of foreign medical schools. Last year, there were several thousand alien physicians engaged in hospitals in the United States. Though such physicians are available for limited periods and do assist in meeting certain needs for that period of time, they may not be considered as available to meet the total physician needs of our population following completion of their training.

To be a sound program in international cooperation and to foster better understanding of the United States in the world, these foreign-trained physicians must be given good educational experience and be shown the best of our medicine and hospitals. The profession and hospitals are taking steps to improve our efforts. Assistance to our institutions in these programs would be, I believe, a proper and valuable thing for our Federal Government to do.

It is recognized that H.R. 6906 includes dental and public health educational facilities as well as medical educational facilities. Inasmuch as this association has adopted no policy recommendations with respect to the needs of schools of dentistry and public health, as they have a much less direct relationship to hospitals, I have not included any particular comments with respect to either of these. However, we have no reason to question their inclusion in the legislation.

We believe that H. R. 6906 promises to provide the necessary financial assistance for the improvement and expansion of our medical school facilities throughout the Nation. We believe this action is of utmost importance to the future health and welfare of the Nation and we urge enactment of this bill.

INSTITUTIONAL GRANTS

We are also interested in the provisions of H.R. 10341, providing for block grants to nonprofit and public hospitals and to others for the general support of programs of research and research training.

This association endorsed the recommendation for block grants made by the Hoover Commission in 1955. The Commission recommended that the system of project grants to institutions or agencies for research pertinent to health be modified and gradually replaced by a program of grants not confined to a specific year, these grants to be made in accordance with an approved overall plan for health research submitted by each institution or agency. Also the block-grant approach was endorsed by the Bayne-Jones study, "The Advancement of Medical Research and Education Through the Department of Health, Education, and Welfare Final Report of the Secretary's Consultants on Medical Research and Education," by the report of the Surgeon General's Consultants Group on Medical Education, "Physicians for a Growing America,"

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