EXECUTIVE OFFICE OF THE PRESIDENT, Hon. OREN HARRIS, BUREAU OF THE BUDGET, Washington, D.C., March 24, 1960. Chairman, Committee on Interstate and Foreign Commerce, MY DEAR MR. CHAIRMAN: This will acknowledge your letter of February 16, 1960 requesting the views of the Bureau of the Budget on H.R. 10341, a bill to amend the Public Health Service to authorize grants-in-aid to universities, hospitals, laboratories, and other public or nonprofit institutions to strengthen their programs of research and research training in sciences related to health. The Bureau has previously reviewed this proposed legislation in draft form and would recommend enactment for the reasons stated in the letter of transmittal to the Speaker of the House of Representatives from the Department of Health, Education, and Welfare. Sincerely yours, PHILLIP S. HUGHES, Assistant Director for Legislative Reference. Hon. OREN HARRIS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Chairman, Committee on Interstate and Foreign Commerce, June 3, 1960. DEAR MR. CHAIRMAN: This is in response to your request of April 13 for a report on H.R. 11651, a bill to authorize a 10-year program of scholarships for medical and dental education, and for other purposes. The bill would amend the Public Health Service Act by adding a new title VIII to authorize a 10-year program of grants to schools for scholarships for medical and dental students, and grants to hospitals for loans to interns. Appropriations of $10 million a year for medical and dental student scholarships, and $2 million a year for intern loans would be authorized for the 10-year period. The proposal is that these programs would be wholly federally financed. Scholarships would be required to be awarded to medical and dental students on the basis of ability and financial need and conditioned on satisfactory scholastic achievement. The maximum for any one student would be $2,500 a year for not longer than the normal course of study. Intern loans would be available from loan funds established by hospitals pursuant to agreements with the Surgeon General-to interns employed by hospitals (which are defined to include diagnostic or treatment centers and related facilities) in their intern training programs. Interns to be awarded loans would also be selected on the basis of ability and financial need. Maximum amounts fixed for such loans would be $2,500 in any one year and $7,000 for all years to any one intern. Other loan conditions and terms would be fixed by regulation of the Surgeon General, but repayment (including interest at not to exceed 2 percent) would be made over a 10-year period, beginning 1 year after termination of the borrower's full-time intern training program. No interest would accrue during the period of training or while the borrower was serving in the military forces. As pointed out in our report to your committee on H.R. 10255, the proposed Medical and Dental Student Scholarship Act, we are fully aware of the extremely heavy expenditures both of time and of money-required of the student and his family in order to complete his medical education, and the years spent in intern programs in teaching hospitals are a significant part of the problem. As we further pointed out, however, the problem of expanding training capacity has, in our view, a prior claim on our attention and upon available Federal tax funds. In addition to the problems (briefly outlined in our report on H.R. 10255) of the relationship of such a student-aid program to overall Federal policy on student aid in other fields of higher education, the instant proposal raises the complex issues of the identification and equitable distribution of the operating costs of the various services and activities carried on by the teaching hospitals of the country. These are now shared among students, patients, public and private educational institutions, and the general public, with the public's share consisting of voluntary contributions to and tax support of hospitals. For example, there are yet to be developed clear-cut concepts for the allocation of the costs of the intern program-between costs of training as distinguished from the costs of patient care, and the return made by the student in the form of service to patients. For the reasons we have outlined, we recommend against enactment of H.R. 11651. The Bureau of the Budget advises that it perceives no objection to the submission of this report to your committee. Sincerely yours, ARTHUR S. FLEMMING, Secretary. VETERANS' ADMINISTRATION, Hon. OREN HARRIS, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. HARRIS: The following comments are submitted in response to your request for a report by the Veterans' Administration on H.R. 11651 86th Congress. The bill would amend the Public Health Service Act to establish a 10-year program of scholarships for qualified medical and dental students and loans to qualified interns. If enacted, the bill would be administered by the Department of Health, Education, and Welfare and would appear to impose no additional administrative responsibilities on the Veterans' Administration. The only specific reference to our activities is contained in section 803 (f) which provides that no scholarship shall be awarded to any individual for any period during which he is receiving education and training as a veteran or under any other law of the United States providing financial assistance to veterans. Section 1632 (h), title 38, United States Code, provides that no veteran shall be paid an education and training allowance for any period during which he is enrolled and pursuing a course of education or training paid for by the United States where the payment of the allowance would constitute a duplication of benefits paid to the veteran from the Federal Treasury. A similar prohibition (38 U.S.C. 1762 (b)) against duplication of benefits is applicable to the program of educational assistance to the children of certain deceased war veterans established by the War Orphans' Educational Assistance Act of 1956. These provisions in our laws would prevent our paying an educational allowance to either a Korean conflict veteran or a "war orphan" who was receiving a scholarship payment under the terms of the proposed legislation. However, there would be no such prohibition in the case of a loan described in section 804 of the bill. As the Nation's largest employer of physicians and dentists and because of our close relationship with medical schools, we have a justified interest in the welfare of students and interns who would be recipients of scholarships and loans under the proposed program. The relative decrease in number of medical students and the long-range need of the country for additional health service personnel have been well documented. The forecast shortage of trained medical personnel would jeopardize both the quantitative and qualitative aspects of our veterans' patient care program. For this reason, we are vitally interested in an increase in the number of available persons in the medical and dental professions. However, because the methods for producing this result are matters of general policy, the Veterans' Administration defers to the Department of Health, Education, and Welfare, which we understand is providing your committee with views on the merits of the bill. Advice has been received from the Bureau of the Budget that there is no objection to the submission of this report to the committee. Sincerely, SUMNER G. WHITTIER, Administrator. DEPARTMENT OF THE NAVY, OFFICE OF THE SECRETARY, Washington, D.C., June 20, 1960. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, MY DEAR MR. CHAIRMAN: Your request for comment on H.R. 11651, a bill to authorize a 10-year program of scholarships for medical and dental education, and for other purposes, has been assigned to this Department by the Secretary of Defense for the preparation of a report thereon expressing the views of the Department of Defense. The proposed bill would authorize the Suregon General, Public Health Service, upon recommendation of an expert advisory committee, to pay scholarships, for not to exceed 4 years, on behalf of students who meet certain qualifying standards. Grants will be paid to approved schools in a sum not to exceed $2,500 per year, per scholarship student. The proposed bill also sets up a system by which certain deserving interns will be authorized, after approval, to borrow, from funds made available for this purpose, $2,500 per year during internship with total loans per intern not to exceed $7,000. The proposed bill would institute a 10-year program for scholarships and loans. Total appropriation for scholarships would be $10 million per year and $2 million per year for intern loans. The proposed legislation is a matter which falls primarily under the Department of Health, Education, and Welfare. The Department of the Navy, on behalf of the Department of Defense, defers to the Department of Heatlh, Education, and Welfare on H.R. 11651. This report has been coordinated within the Department of Defense in accordance with procedures prescribed by the Secretary of Defense. The Department of the Navy has been advised by the Bureau of the Budget that there is no objection to the submission of this report on H.R. 11651 to the Congress. T. P. SMITH, Jr., (Acting Deputy Chief for the Secretary of the Navy). Mr. ROBERTS. Our first witness this morning is our colleague from Florida, the Honorable D. R. (Billy) Matthews. Mr. Matthews, it is a pleasure to have you this morning and you may proceed. STATEMENT OF HON. D. R. MATTHEWS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA Mr. MATTHEWS. Mr. Chairman, please let me thank you for the opportunity of appearing before you. I am impressed with the provisions of Mr. Fogarty's bill which would authorize a program of grants for construction of medical, dental and public health educational facilities. Two areas of the health sciences are not covered by this bill; namely, pharmacy and nursing. All are related and all are necessary to a broad health program. I should like to point out that in my own State of Florida medical education is a newcomer on the scene. Until very recently we had no medical school in Florida. A State which was undergoing the greatest population growth in the Nation was without medical educational facilities for its youth. Other States having medical schools could not admit even a small percent of qualified undergraduates with the result that Florida was sorely in need of medical practitioners. This unfortunate situation is now on the way to being corrected. A truly great medical center has been established at the University of Florida in Gainesville-the J. Hillis Miller Health Center-which represents an investment of about $20 million. This health center was planned after consultations with leading deans of medical schools and heads of hospitals throughout the land, and the concept, which is somewhat new, is that all of the health-related sciences should be represented. We have a medical college, a college of pharmacy, a college of nursing, and a college of health-related sciences. Only a college of dentistry is missing, but I understand this will come later as it is included in the master plan. All but pharmacy are newcomers in this group. Pharmacy has been a long-established college at the University of Florida, yet it was merged with or became a unit of the health center. The nursing situation in Florida, as in other parts of the Nation, is a perennially acute one. Our State has taxed its resources to the breaking point and other educational needs have had to be sacrificed for this initial effort in behalf of a comprehensive health program. I cite these facts in order to show the truly great interest Î have in this legislation, and the fact that it does not seem complete without including pharmacy and nursing with the other major health fields named in the bill. The deans of two pharmacy schools in Florida are urging inclusion of their profession within the scope of this bill. One heads up the school of pharmacy at our Florida Agricultural and Mechanical University, a wonderful institution which serves the Negro youth of our State at Tallahassee. The other heads up our college of pharmacy at the University of Florida. At the latter, a 5-year undergraduate program for a degree in pharmacy has recently been approved. Nursing schools exist at all of our State-supported universities. Authorizations of Federal aid for construction in these fields would seem to be a partial answer to our national dilemma with respect to need for expanded medical care for our people. They are specialized and temporary aid measures which need not become a chronic drain on the Federal Treasury. The provisions of the bill with respect to scholarships and research grants are equally pertinent to pharmacy and nursing education, and I hope these two additional areas may be included in the bill. Mr. ROBERTS. Thank you, Mr. Matthews. Are there any questions? If not, thank you again. Mr. MATTHEWS. Thank you, Mr. Chairman. Mr. ROBERTS. Our next witness is another colleague of ours, the Honorable Seymour Halpern of the State of New York. Mr. Halpern, we are delighted to have you before the subcommittee this morning. You may proceed, sir. STATEMENT OF HON. SEYMOUR HALPERN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK Mr. HALPERN. Thank you, Mr. Chairman. Mr. Chairman and members of the committee, thank you for the opportunity of appearing before you today in behalf of my bill, H.R. 11651. This bill would authorize a 10-year program of Federal medical and dental scholarships and a 10-year program of loans to interns. In support of this bill I call attention to the publication by the Department of Health, Education, and Welfare in October 1959, of the study entitled "Physicians for a Growing America," the report of the Surgeon General's consultant group on medical education. Nothing could more starkly or graphically depict the serious situation confronting our Nation's medical and dental schools and the scope of the need for student financial aid than the facts in the pages of this booklet. While the publication deals with the question of enlarging our medical and dental school facilities and of recruiting faculties in addition to providing financial aid to students and interns, my remarks will be restricted to the latter phase of the problem. Other bills before the committee incorporate provisions in respect to assistance to medical schools. H.R. 11651 is limited to the vital area of financial aid to future doctors, physicians, and dentists. The seriousness of the condition with which the report deals is evidenced by its opening paragraphs: The current output of medical schools will not be adequate to maintain the current ratio of physicians to population. * * * To retain this ratio would require by 1975, an annual 11,000 graduates, 3,600 more than were graduated in 1959. Expansion of the output of physicians will require a substantial increase in the supply of well-qualified students. Foremost among the factors that may prevent increased enrolled of qualified students in medical schools are the growing number and variety of competing professional opportunities, the high cost of medical education, both in dollars and time, and the lack of financial assistance available to medical students as compared with assistance available for education in related scientific fields. Population rise, medical specialization, and the increase in the use of personal medical services are factors affecting the growing need for physicians in this country. The ratio of physicians per 100,000 people in the United States fell from 143 to 140 between 1949 and 1959. Medical schools are not turning out enough trained men and women to keep this figure from becoming worse, and what is equally disturbing is that some evidence exists indicating that the quality of medical students is not as high now as it was a few years ago. If larger numbers of intelligent and well-motivated young people are to be drawn into the medical profession, it is important that a realistic appraisal be made of circumstances that seem to limit the supply of students today. Among such circumstances, as the report makes clear, are the time requirements for the completion of medical studies a total of 5 to 10 years in schools and hospitals after completing undergraduate work-and the cost of a medical education. The average cost of such an education considerably exceeds the cost of education for most other professions. Medical school tuition tends to be higher than tuition for most other types of advanced training in the same university. Perhaps the situation can be presented most forcibly by reference to excerpts from the summary of the chapter in the report on the supply of students: 7. The medical student or his family, besides financing a college education, must meet expenses averaging $2,386 for each of 4 years in medical school, $3,271 for a married student. During an additional 1 to 6 years in internship |