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$342.814 million for fiscal year 1992. This represents a 12-percent cut. Overall, the number of SCSEP positions would decline by 7,844, from 64,405 authorized positions for fiscal year 1991 to 56,561 for fiscal year 1992. If the Administration's proposal should become law, NCBA estimates that 1,875 to 2,625 older Blacks would be terminated from the program. In many cases, these individuals would be among the poorest of the poor in the United States.
NCBA strongly believes that it is simply not enough to reject the Administration's proposal. The Subcommittee must approve a realistic appropriation which allows Title V to respond to the major needs of low-income older Americans and the communities they serve in a fiscally responsible manner.
NCBA is calling for a $415 million funding level to achieve this objective. This is $15 million more than the $400 million which the Congress approved for the SCSEP for fiscal year 1990, prior to the 2.41-percent across-the-board reduction for nearly all Labor-HHS-Education activities. The $400 million appropriation was necessary to prevent a loss of Title V positions because of the two-step increase in the Federal hourly minimum wage. Our proposal for a $415 million funding level for fiscal year 1992 would achieve two objectives:
First, it would restore the number of Title V positions to the level prior to the minimum wage hike.
Second, it would partially take account of inflation since Congress acted to prevent a loss of positions because of the Federal minimum wage increase. Our proposed inflation adjustment, we should stress, is less than the projected inflation rate when using a $400 million baseline. We are doing this because we fully recognize that the fiscal year 1992 budget will be extremely tight.
For these reasons, we reaffirm our support for a $415 million funding level for Title V for fiscal year 1992.
TITLE IV TRAINING, RESEARCH AND DISCRETIONARY PROJECTS
Additionally, NCBA urges that funding for the Older Americans Act Title IV Training, Research, and Demonstration program be increased from $26.9 million in fiscal year 1991 to $28.5 million in fiscal year 1992. This modest increase would help the U.S. Commissioner on Aging to launch her initiatives to improve the quality of life for older Americans in a number of high priority areas, such as boosting minority participation in Older Americans Act programs, elder care, and other initiatives. NCBA further urges the Subcommittee to approve report language to call upon the Administration on Aging to provide additional funds for (1) projects to promote minority participation in Older Americans Act programs and (2) gerontological activities undertaken by historical Black colleges and universities.
In conclusion, NCBA welcomes the opportunity to appear before this Subcommittee. We appreciate your past support in funding programs for low-income older Americans. We look forward to working with you and your staff in the future. Thank you again for your consideration.
STATEMENT OF SHARON SURREL, TECHNOLOGIST SECTION, SOCIETY OF NUCLEAR MEDICINE
Senator REID. The committee will now hear from Sharon Surrel of the technologist section of the Society of Nuclear Medicine. Ms. SURREL. Thank you and good morning, Senator.
Senator REID. I appreciate your patience in waiting until we got to you.
Ms. SURREL. Thank you.
I am Sharon Surrel, certified nuclear medicine technologist and manager of the Department of Nuclear Medicine, Washington Hospital Center, Washington, DC, I am pleased to represent the Society of Nuclear Medicine Technologist Section. The society is a scientific organization of over 10,000 members, including 5,000 members of the technologist section.
We strongly support the reauthorization of title VII of the Public Health Service Act and appropriations necessary to revitalize essential training programs for the allied health professions. Nuclear
medicine is the medical specialty that uses small amounts of radioactive materials for diagnostic and therapeutic procedures. The nuclear medicine technologists under the supervision of a physician directs or participates in the daily operation of the nuclear medicine department.
The decline in the number of allied health professionals, compounded by an increased demand, has created a crisis situation in the health care system that threatens access to quality medical care. This crisis is apparent in the field of nuclear medicine as hospitals and training programs have been unable to attain recruitment and retention goals for qualified nuclear medicine technologists at a critical time when the available technology has greatly enhanced diagnostic and therapeutic capabilities.
From 1985 to 1990, the number of nuclear medicine technology programs decreased 22 percent. During the same period there was an 18-percent decrease in the number of applicants taking and passing the certification exam in nuclear medicine technology. Ultimately decreases in enrollees and prospective examinees result in fewer practitioners.
A 1987 survey conducted by the technologist section indicates great difficulty in filling technologists positions. According to the American Hospital Association 1989 survey of human resources, the full-time vacancy rate for nuclear medicine technologists is 8.9 percent; 7 percent is the benchmark used in the survey to define a shortage.
Since the advent of the prospective payment system in 1983, cost control has become a decisive factor in hospital management. These changes in reimbursement and a shift in utilization from inpatient to outpatient diagnostic imaging centers have contributed to the shortage of qualified nuclear medicine technologists with the closing of hospital-based programs which are considered as nonrevenue producing. Technological advances have resulted in an increase in the types and complexity of nuclear medicine procedures being performed. Nuclear medicine exams are cost-effective diagnostic tests and are expected to be utilized even more in the future, given the cost control initiatives implemented by health care providers and insurers.
The technologist section has been active in developing and implementing recruitment strategies that promote and market nuclear medicine technology as a career through public relations activities and the development of scholarship funds. However, Federal assistance is necessary to help nuclear medicine schools recruit and retain qualified faculty.
The technologist section is gravely concerned about the declining number of qualified nuclear medicine technologists. We fully support the recommendations of the American Society of Allied Health Professions to reauthorize and amend title VII of the Public Health Service Act and to appropriate funds for the following activities: entry level education, $12 million; advanced level traineeships, $12 million; grants and contracts, $12 million; allied health research, $20 million; Commission on Allied Health, $1.5 million; allied health data system, $5 million. We also support a division of allied health to be established within the Bureau of Health Professions.
The Society of Nuclear Medicine technologist section believes that the manpower shortage is the greatest issue currently facing nuclear medicine technology. We urge your support for a comprehensive Federal initiative. We believe there should be equality in the Federal Government's support for the training of all administration care professionals: allied health practitioners as well as physicians. An immediate response to this problem must be forthcoming to remedy the current manpower dilemma and deter a potentially more serious manpower shortage in the future.
I thank you, sir.
[The statement follows:]
STATEMENT OF SHARON SURREL
The Society of Nuclear Medicine Technologist Section strongly supports the reauthorization of Title VII of the Public Health Service Act and appropriations necessary to revitalize essential training programs for the allied health professions. The Society of Nuclear Medicine is a scientific organization of over 10,000 members, including 5,000 members of the Technologist Section.
Nuclear medicine is the medical specialty that uses small amounts of radioactive materials for diagnostic and therapeutic procedures. There are approximately 10 million diagnostic nuclear medicine procedures performed annually in the United States. One of every three hospital inpatients is likely to undergo a nuclear medicine procedure. The nuclear medicine technologist (NMT), under the supervision of a physician, directs or participates in the daily operation of the nuclear medicine department. The responsibilities of the NMT are varied and include: preparing and administering radiopharmaceuticals; positioning patients for imaging procedures; interacting with patients; operating nuclear medicine equipment; maintaining radiation safety; analyzing biologic specimens; computer data analysis and performing quality control measurements.
The decline in the number of allied health professionals, compounded by an increased demand, has created a crisis situation in the American health care system that threatens access to quality medical care. This crisis is also apparent in the field of nuclear medicine as hospitals and training programs have been unable to achieve their goals in recruitment and retention efforts for qualified nuclear medicine technologists at a critical time when the available technology has greatly enhanced diagnostic and therapeutic capabilities.
According to statistics from the Joint Review Committee on Educational Programs in Nuclear Medicine Technology, for the academic year 1988-1989, the enrollment was approximately 73 percent of student capacity. Data for 1990 from the Committee on Allied Health Education and Accreditation indicates that there are 110 accredited nuclear medicine technology programs, a decrease of 22 percent from 1985. The Nuclear Medicine Technology Certification Board (NMTCB) reported that for the period 1985-90 there has been an 18 percent decrease in the number of applicants taking and passing its examination. Ultimately, decreases in enrollees and prospective examines result in fewer practitioners.
In 1987, the Technologist Section conducted a survey of the directors of departments of nuclear medicine to determine the impact of the Prospective Payment System (PPS) on the delivery of nuclear medicine services. Over 34 percent of the respondents required more than three months to fill a technologist position. Fortythree percent of the respondents indicated that there had been a decrease in the supply of nuclear medicine technologists in their area. In regard to the perception of the supply of nuclear medicine technologists in their geographic area, 57 percent of the respondents perceived a shortage as compared to 19 percent in 1984 in the Technologist Section's Human Resource Survey. Similar responses are reflected in the American Hospital Association's (AHA) 1989 Survey of Human Resources. According to the AHA survey, the full-time vacancy rate for nuclear medicine technologists is 8.9 percent; seven percent is the baseline used in the survey to define a shortage. It is interesting to note that the U.S. Labor Department projected a 30 percent increase in jobs in the U.S. between 1988 and 2000 for nuclear medicine technologists.
Since the advent of the Prospective Payment System in 1983, cost control has become a decisive factor in hospital management. These changes in reimbursement
and a shift in utilization from inpatient to outpatient diagnostic imaging centers have contributed to the shortage of qualified nuclear medicine technologists with the closing of hospital based training programs which are recorded as non-revenue producing. Technological advances have resulted in an increase in the types and complexity of diagnostic imaging procedures being performed. Nuclear medicine exams are cost effective diagnostic tests and are expected to be utilized even more in the future, given the cost control initiatives implemented by health care providers and insurers.
The Society of Nuclear Medicine Technologist Section has been active in developing and implementing recruitment strategies that promote and market nuclear medicine technology as a career through public relations activities and the development of scholarship funds. However, Federal assistance is necessary to aid individual educational programs in implementing their own recruitment efforts. In addition, Federal assistance is needed to help nuclear medicine schools recruit and retain qualified faculty. The Technologist Section is offering assistance in this area by sponsoring workshops each year for educators, focusing on topics such as clinical evaluation, curriculum development, and faculty development and retention.
As quality of care and access to health care are dominant themes in the health care delivery system, consideration must be given to the implications of the decreased number of nuclear medicine technologists. Specifically, as the patient population ages, more nuclear medicine procedures will be performed to detect cancer, neurological diseases and cardiac diseases. Significant implications in the clinical applications of radioisotope imaging have evolved in the last decade as a result of new indications for established radiopharmaceutical procedures, the refinement of imaging modalities and the approval of new radiopharmaceuticals. NMT's will require additional training in order to perform the more complex procedures. The current shortage of NMT's aggravates this problem, and if allowed to persist, will severely curtail the provision of critical medical services.
The Technologist Section is gravely concerned about the declining applicant pool of qualified nuclear medicine technologists. We fully support the recommendations of the American Society of Allied Health Professions (ASAHP) for fiscal year 1992 that address the allied health manpower crisis:
-Entry-level education traineeships ($12 million)-grants to educational programs to assist students in meeting the costs of entry-level education. -Advanced-level traineeships ($12 million)—-grants to training centers for doctoral programs and traineeships to doctoral or post-doctoral students. -Grants and Contracts ($12 million) comprehensive program to benefit academic and clinical research initiatives.
-Allied Health Research ($20 million)-support for innovative research projects, including projects to develop the basis for practice in allied health professions. -Commission on Allied Health ($1.5 million).
-Allied health data system ($5 million) create a comprehensive and uniform national database to monitor trends in allied health manpower and education and to make projections on allied health requirements in the future.
-Division of Allied Health within the Bureau of Health Professions (5 full-time equivalent personnel)-in conjunction with the Commission on Allied Health, to represent the allied health professions and advise Federal agencies and congressional committees.
The Society of Nuclear Medicine Technologist Section believe that the manpower shortage is the greatest issue currently facing nuclear medicine technology. We urge your support for a comprehensive federal initiative. We believe there should be equity in the Federal government's support for the training of all health care professionals: allied health practitioners as well as physicians. An immediate response to this problem must be forthcoming to remedy the current manpower dilemma and deter a potentially more serious manpower shortage in the future.
Senator REID. Ms. Surrel, a number of the items you have listed in your request for more money talk about things like entry level traineeships, and advanced level traineeships. The question that I have is if your profession were paid more, would there still be the need for the Government to be involved? What I am saying is maybe everybody is just underpaid.
Ms. SURREL. Underpaid, you mean in the profession itself?
Senator REID. That is right. If, in fact, these jobs paid more, wouldn't these programs-shouldn't they be funded by the institutions that need the technologists?
Ms. SURREL. Well, the programs that are being proposed here from the ASHAP are to be provided to all the allied health professions, not just nuclear medicine technologists.
Senator REID. OK.
Ms. SURREL. We support this particular proposal in title VII.
Ms. SURREL. Yes; I am representing my own field as well as others. But my whole society is supporting these initiatives because, first of all, the problem we have found in speaking to a variety of different Senators and people on the Hill is that they do not seem to recognize what the allied health professions are. And what we thought needs to be done is that each of our professions, whether you are respiratory therapy, physical therapy, nuclear medicine, diagnostic radiology-we are all suffering because a lot of the high school kids are not going into the allied health professions. They do not even know that they exist or what we do.
Senator REID. Are there jobs available?
Ms. SURREL. There are jobs available. In some cases schools have had to close because of prospective payment that were hospitalbased programs. And each of the professions has a different need, whether it is recruitment or retention or even as in some of these programs here, the advanced level traineeships is to have educators to be able to teach in these programs. There is not enough of those. And if we do not have enough people in our professions to do the tests in the hospital that need to be done, they are not going to get done. Patients are going to stay in the hospital longer.
Over the last few years, much money has been given to nursing, but all the other allied health professions have not even been thought of. Last year there was $1.4 million given under title VII for all the allied health professions
And there are at least 15 or 16 different associations and societies that exist out there that are involved in the allied health professions, and no one knows that we exist. We have been trying our best to make ourselves known to the Hill because it is coming. It is true. Many surveys have been done. There are shortages there, and they are going to continue, and patients are going to end up laying in the hospital longer and longer rather than getting out as they should because all the hospitals are suffering shortages of our personnel.
Senator REID. I understand. I appreciate your testimony. It is very clear.
That's all the questions we have. You were the final witness.
Senator REID. You are welcome. The subcommittee will stand in recess until 9:30 a.m., Tuesday, April 23, when we will meet in SD-192 to continue our public witness hearings on the administration's fiscal year 1992 budget request.
[Whereupon, at 12:05 p.m., Thursday, April 18, the subcommittee was recessed, to reconvene at 9:30 a.m., Tuesday, April 23.]