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way. These funds provide incentives to students to enter these nursing programs,
especially helping to finance minority students in need of education stipends.
Directors of all thirty educational programs are also seeking additional sources of
funding -- from state governments, from private foundations and from faculty generating
service dollars. This later practice is dependent on the state laws under which a CNM
is licensed, as well as the CNM's ability to gain hospital privileges -- barriers to practice
which still restrict nurse-midwifery in some areas of the country. In fact, the availability of
this option for nurse-midwifery faculty is much more limited than for faculty at medical
schools. Faculty are further limited since they provide care for underserved patients and
this type of health care service cannot subsidize the educational programs.
Return on Investment
The federal funds that have been spent over the past ten years on nurse-midwifery
education have been repaid many times over by CNM's services to the poor and
underserved in the United States.
Today, nurse-midwifery practices exist in all 50 states, and in many developing
countries around the world. Certified nurse-midwives can be found in hospital settings,
in clinics, and in privately owned birthing centers. Fortunately the tradition of providing
care to the poor continues. This is especially important in light of information which
indicates that obstetricians are caring for smaller numbers of Medicaid clients.
A Safe Cost Effective Alternative
Over the years nurse-midwives have maintained a superb record of safety and
client satisfaction. Nurse-Midwifery is also a highly cost-effective approach to health care
delivery. Hospital stays tend to be shorter and care regimens less technologically
complex when not medically necessary with nurse-midwife assisted deliveries.
A Significant Contribution To Healthier Births
One of the maternal and infant health objectives set by Healthy People 2000 is to
: "Increase to at least 90 percent the proportion of all pregnant women who receive
prenatal care in the first trimester of pregnancy". This objective is imperative since early,
high-quality prenatal care is critical to improving pregnancy outcomes and reducing A number of studies have shown that care by nurse-midwives increases utilization of prenatal care facilities, and that such care lowers the risk of low birthweight, prematurity
and neonatal death. Recent reports by the National Academy of Science's Institute of
Medicine, the Southern Governors' Association Task Force on Infant Mortality and the
Children's Defense Fund highlight nurse-midwives' outstanding contribution to preventing
Another objective stated by Healthy People 2000, 'Increase to at least 60 percent
the proportion of primary care providers who provide age-appropriate preconception care
and counseling' also can be achieved by using nurse-midwives as providers. Certified
nurse-midwives endure that their patients are healthy prior to pregnancy, there by
reducing the risk of problem pregnancy and poor outcome. We care for all women
regardless of income, social status, or ethnic background.
At this time we are requesting $20.000.000 to meet the educational needs of
nurse-midwives/nurse practitioner programs.
Presently, only nine nurse-midwifery
programs are being funded. The additional funding requested is only enough to fund 4
6 additional new nurse-midwifery/nurse practitioner programs. These funds will help
afford student scholarships as well as provide educational supplies, equipment and help
pay for faculty salaries.
The program at Georgetown University graduates 15 students annually.
The American College of Nurse-Midwives urges Congress to appropriate funding
levels adequate for the educating of sufficient numbers of nurse-midwives and other
nurses with advanced nurse education.
Certified nurse-midwives have a rich tradition of providing access to care for the
poor and other underserved, populations. This service more than compensates
for the federal funding which has supported the educational programs in the past.
Continued growth of nurse-midwifery in the United States will help address two
serious national health problems -- the persistently high rate of low birthweight and
premature births, and the rising cost of health care.
STATEMENT OF THE ST. GEORGE'S UNIVERSITY
SCHOOL OF MEDICINE
Mr. Chairman and members of the Subcommittee, thank you for
not only benefit the St. George's University School of Medicine
The St. George's University School of Medicine has a growing
teaching hospitals that treat and care for great numbers of poor
and indigent patients, 80-90% of residency positions are filled
by graduates of international medical schools.
In the United
States there would be a significant problem caring for indigent
and poor patients if not
for residency slots being filled by
eager graduates from non-U.S. schools such as St. George's.
Journal of the American Medical Association
January 18, 1985 issue reported that the St. George's University
School of Medicine had the highest initial pass rate of all the
leading international medical schools in the world on the U.S.
approximately one-third of that class qualifies and transfers to U.S. medical schools to complete their education.
domestic medical schools will take the same licensing exam,
as the United States Medical Licensing Examination,
thereby allowing their skills to be compared on an equitable
state-to-state licensure by endorsement process by limiting
Chairman, I bring these examples to your attention to
discriminatory barriers have begun to come down. However, there is no mistaking that discrimination toward graduates of foreign
medical schools is common, particularly in the areas of residency position acceptances, as well as in the areas of licensure, jobs, hospital promotions, privileges and peer reviews.
FY'91 proposes a large cut in Health Education Assistance Loans