cine and public health to meet the increasing manpower needs of a rapidly expanding population.

However, I would like to cite just a few figures to demonstrate the magnitude of the problem which now exists and which is worsening daily.

Two major studies within the past 2 years (Bayne-Jones report and the Bane report) have come to the conclusion that the dental needs of the population cannot be accommodated at the level available today unless the number of dental graduates is increased from the present 3,250 annually to about 6,200 a year. To do this will require the construction of 15 to 20 additional dental schools by 1970, or the expansion of existing schools to a comparable degree.

Recent studies show that the colleges and universities which presently have dental schools have invested more than $60 million in new construction or improvement during the past decade. The American. Association of Dental Schools is confident that the dental profession and the dental schools can find the means of providing the dental manpower needed by the public but, to do so, there must be an appreciable increase in financial assistance from the Government, both Federal and local, as well as the private sources which have carried a heavy part of the burden since the beginning of dental education in this country.

FEDERAL GRANTS FOR THE CONSTRUCTION OF TEACHING FACILITIES

The excellent staff report prepared for this committee in 1957 presents detailed statistics on the dimensions of the need for additional dental school construction.

Since that report was issued, the situation has become even more critical and there is no doubt but that this trend will continue unless something is done immediately.

Two or three years ago the dental profession was being increased by about 1,000 dentists a year (taking into account the number of deaths and retirements and the number of new graduates) but now we find that this increase in the number of active dentists has diminished to about 800 a year.

At the same time, the population of the country has been increasing at the rate of about 2,800,000 a year. These statistics, although portraying only a part of the picture, show that we are producing today 700 fewer dentists a year than are needed to care for the increasing population on the basis of the present dentist-to-population ratio.

Every year of delay in providing a part of the financial assistance needed for the construction of expanded dental education facilities will make this problem more critical.

In considering the possibility of Federal grants for the construction of dental teaching facilities at its 37th annual session this year, the American Association of Dental Schools adopted a policy statement reemphasizing the seriousness of this situation and urging the Federal Government to support the construction and equipping of new dental educational facilities, in an amount consistent with national policies and national resources.

Special emphasis was given to the desirability of including provision in such legislation for the expansion and rehabilitation of existing institutions in preference to a program to support only new con

struction. We are pleased to see that Representative Fogarty's proposal includes such provisions and urge that a pattern such as outlined in H.R. 6906 be adopted by the committee.

However, with specific reference to H.R. 6906, we would like to submit two recommendations for the consideration of the committee. Section 803 (3) (c) states that existing medical schools shall be eligible for grants not to exceed $3 million during the 5-year period while existing dental schools shall be eligible for a maximum of $1 million for the 5-year program.

It is assumed that the reasons for this provision must be either (a) the belief that construction of medical teaching facilities-exclusive of hospital construction presently authorized under the HillBurton program-is 200 percent more expensive than the cost of dental school construction, or (b) there is a relatively greater need for the expansion of medical education facilities.

We do not believe that evidence is available to demonstrate the first of these assumptions and, in fact, would suggest that the construction cost per student in dental school is equivalent to or higher than the similar cost in medical education.

I would like to cite a personal instance in my own university which completed in the past year a research and diagnoses building and the vice president for business administration told me that the dental section which comprised about 15 dental chairs and units cost 10 times a square foot the cost of the rest of the building.

The data would seem to support the need for more funds for the expansion and rehabilitation of medical schools because of the larger number of institutions involved in medical education. We feel, however, that this need, if it exists, will be met by a greater number of applications from medical schools and that there should not, and need not, be a differentiation on the basis of allowances for dental and medical education.

Further to support our reasons for proposing a change in section 803 (3) (c), it should be mentioned that a substantial portion of the immediate increase in enrollment which might be expected from enactment of construction grant legislation is likely to come from the existing institutions. There are over 30 schools which could anticipate nearly immediate construction of an expanded facility if Federal funds were to be made available and in 13 of these cases, the construction and equipment involved would exceed substantially the limits imposed by the present section 803 (3) (c).

We would urge the committee either to eliminate this section entirely or raise the maximum allowance for existing dental schools to the $3 million provided for schools of medicine.

As a technical amendment, we would also propose that section 802 (5) be amended to read the same as section 802(4). This would simply provide a mechanism for qualifying those new dental schools which cannot achieve official accreditation by the Council on Dental Education until they have completed 4 years of operation.

SCHOLARSHIPS FOR DENTAL STUDENTS

Close to the top of the list of problems facing dental education today is the difficulty of obtaining sufficient numbers of well-qualified students to enter the study of dentistry. The following figures show

the trend which has taken place in the number of applicants to dental schools during the past 4 years:

It will be observed that the ratio of applicants to accepted students has decreased steadily during this period to the point where the ratio reached a 15-year low in 1958 and 1959.

In the fall of 1959 there were 15 dental schools which did not fill their first-year classes. On a national basis, there were about 140 vacancies in the dental schools in the country last fall and there is reason to believe that this situation will be at least as serious this fall. This condition is the result of many influences. An expanding economy with more scientific and technical fields of employment, decrease in the number of college students until 3 or 4 years ago, andperhaps most important of all-the steadily increasing cost of dental education, have all contributed to the shortage of well-qualified dental applicants.

The American Association of Dental Schools, along with other agencies of the dental profession, has already started programs of recruitment for dental education. The combined investment of the dental profession on recruitment activities this year will amount to thousands of dollars. We are convinced, however, that all of these efforts toward recruitment will be only partially successful so long as the economic barrier to the study of dentistry exists for such a large part of our well-qualified young people.

Dental education requires a minimum of 6 years of education beyond high school; 2 years of preprofessional study and 4 years of dental school.

At graduation, the new dentist must invest at least $6,000 for the establishment of his private office. On the basis of recent information, the college student contemplating the study of dentistry must plan to invest a minimum of $22,000 before he accepts his first patient and the national average exceeds $26,000.

There is no way to state precisely the number of students who might have considered dental school had this formidable economic investment not existed. We do know, however, that even those students who are enrolled accrue a substantial debt by the time of graduation. Sixty-seven percent of the dental school seniors have an average debt of $4,500-with one-third of these owing more than $6,500 by the time they are graduated.

Only one dental student in 12 has a scholarship to help defray his expenses and these scholarships represent only 0.6 percent of the student costs.

Even at the high cost of dental education today, the student is paying only a part of the cost of his education. The universities with dental schools are investing an average of about $2,000 a student per year above the costs paid by the student and these costs are rising each year.

According to dental educators, it is impossible to consider any substantial increase in student tuition and fees unless some provision is made for substantial scholarship support for dental students. Private sources of scholarship funds for dental education are sought constantly by the dental schools but experience has shown that dental education simply does not attract the industrial support provided for many of the more dramatic sciences.

Yet when it is realized that dental disease affects the human welfare of 95 percent of our population, it is evident that something must be done to assure an adequate supply of future dentists.

The precedent for Federal concern with a problem of this type is well established through activities such as the National Science Foundation and the National Institutes of Health in the fields of postgraduate education for research and teaching.

The American Association of Dental Schools has adopted a policy statement indicating its belief that—

the Federal Government has a proper concern to aid in meeting the very difficult problems of providing the dental manpower and dental care needed by the citizens of the United States. *** Under acceptable provisions which would assure the continued management and control of all aspects of dental education programs by the administration of the individual schools, the American Association of Dental Schools would, in principle, look with favor upon a program of direct Federal aid for operating support of schools of dentistry. ** The association wishes to encourage the proper agencies of the Federal Government to continue to support legislation which provides student loan and scholarship funds to students interested in the study of dentistry.

There is an essential relationship between the intent to supplement dental school construction by Federal grants and the proposal to assist qualified students in meeting the financial burden of a dental

education.

Representative Fogarty has again demonstrated his acute awareness and understanding of health problems by introduction of legislative proposals in both areas. We have reviewed also the proposal submitted by Mr. Halpern (H.R. 11651) for dental and medical scholarships.

The association urges the support of either of these legislative proposals as a partial solution to the problems facing students entering professional education in the health sciences.

As a matter of policy, the American Association of Dental Schools has recorded its opinion that the relationships which have been developed between the Federal Government and the dental schools in the several years of operation of the program of the National Institute of Dental Research have proven to be fundamentally sound and proper and, therefore, would support a program providing direct Federal grants on a basis such as outlined in H.R. 11651.

We would like to suggest that section 804 of Mr. Halpern's bill be amended to include provision for loans to dental as well as medical graduates in recognized internship training.

Although internship training in dentistry is not commonly required for the practice of the profession, this form of dental education is an important means of postgraduate education and is being pursued by nearly 10 percent of the dental graduates today.

If the period of financial hardship for the dental graduate could be alleviated by a loan program, it is likely that a greater number of dental graduates would complete this additional period of training

and, at the same time, provide the dental services which are in demand by so many of the hospitals in the country today.

INSTITUTIONAL RESEARCH GRANTS

The committee has undoubtedly received ample evidence in support of a program to provide institutional research grants such as outlined in H.R. 10341, so time will not be taken to repeat similar justifications in this testimony.

The American Association of Dental Schools has reviewed the provisions of the plan to provide institutional grants for research and heartily endorses both the concept and provisions which have been proposed.

A program of institutional research grants will undoubtedly encourage the expansion of dental research and facilitate the administration of dental research programs, particularly during the critical stages of formulating new projects and ideas.

I appreciate the opportunity of presenting this statement in behalf of the American Association of Dental Schools. Our association will be pleased to provide any additional information which may be needed by the committee.

Mr. ROBERTS. Thank you, Doctor.

You mentioned in one part of your statement at the top of page 5, in about the third sentence that:

As a matter of policy the American Association of Dental Schools has recorded its opinion that the relationships which have been developed between the Federal Government and the dental schools in the several years of operation of the program of the National Institute of Dental Research have proven to be fundamentally sound and proper, and, therefore, we support a program providing direct Federal grants on a basis such as outlined in H.R. 11651.

Dr. RAULT. Yes, sir.

Mr. ROBERTS. We frequently hear the charge that in these Federal type programs there is, and I certainly agree, the danger of Federal interference as far as the operation and handling of the administration of the schools which share in these funds.

From your experience with the institutional grant situation and, as you mentioned, the NIH, do you think there is any interference on the part of the Federal Government in the practice of dentistry in the sovereign States.

Dr. RAULT. None whatsoever, to my knowledge.

Mr. ROBERTS. Would you say that a large number, a round majority, would support this type of program?

Dr. RAULT. I think they would; yes, sir. I have heard no objec-' tion.

Mr. ROBERTS. Thank you, Dean.

Are there any further questions, gentlemen?

Thank you so much.

Dr. RAULT. Thank you, sir.

Mr. ROBERTS. Mr. Charles W. Bliven, president of American Association of Colleges of Pharmacy, School of Pharmacy, George Washington University, Washington, D.C., and I believe he is accompanied by Raymond J. Dauphinais, director of the legal division, American Pharmaceutical Association.