Dr. HUNDLEY. I just wanted to make a point here, Mr. Springer. You asked whether the Surgeon General had authority to pay salaries. He does, but in a sense I want to be sure that you understand. Any such application, whether it is under the research career award program or part of a research grant, has to be reviewed by both study sections and councils that are composed of outside non-Federal scientists. If they recommend it, the Surgeon General can pay it; if they do not recommend the grant, he cannot pay it. This is written into law insofar as Council action is concerned. The requirement for study section or other scientific review to provide dual review results from administrative action on our part. Mr. SPRINGER. Let me pursue this a little further. This is not going to be general, and I am not going to follow it up with individual instances, but I am trying to get you policy. Do you have authority to make a grant for an individual salary? Dr. HUNDLEY. Yes, sir. We have authority to do this under our research authority. Mr. SPRINGER. Separately from the question of doing research? Dr. HUNDLEY. No. They are research awards either for training or for the doing of research. Mr. SPRINGER. The doing of research? Dr. HUNDLEY. Yes, sir. Mr. SPRINGER. Can he be an administrator doing research and receive a salary? Dr. HUNDLEY. Well, I suppose every researcher is an administrator in a sense, sir. We do not pay salaries to the administrators of research centers or medical schools. We might pay part of the salary of a person in a medical school who spent part time on research and part time on administration. Mr. SPRINGER. I will let that rest for the present. There is one thing that I would hope that I could do before we get into asking individual questions, which I am sure we will want to pursue later on. If you can give within the last 2-year period, or you can go back 3 or 4 or 5, if you want to, the individual grants that were made and the amount of money that was involved in each one and the total overall of the number of grants that were made to institutions I don't care whether it is an educational institution or a research institution at the same time there was a member of the board serving and who also was an employee of the institution or whatever institution it was getting the research grant. Dr. TERRY. Mr. Springer, I think this would be a practically impossible task, with the tens of thousands of grants that are made with the hundreds of people that serve on our council. I, frankly, think it would take us several months to work out such a piece of information. Mr. SPRINGER. Well, may I say, Dr. Terry, I think you are going to be faced with this and it will be much more unpleasant, I think, to be forced to come up with individual instances in which this did take place than to openly and honestly come forward with the instances of where there were members of the board receiving grants. Dr. TERRY. I dare say there have been thousands of such instances. Mr. SPRINGER. I am not opening this up to make an accusation until I have the facts, but I think this is going to have to come out some time as to who has been serving on the boards and whether or not grants have been made to research institutions or colleges or universities or whatever it was. With that, I will let it rest for whatever you want to do. Dr. TERRY. I will assure you there have been literally thousands of such instances of grants made, recommended by council, in which there was a member of the council from that particular university. Mr. SPRINGER. Would you turn to chart 3 for just a minute? Mr. Chairman, I will thank you very kindly for your indulgence. For the identification of the record, this is NIH functions and program components, 1963. Dr. Terry, it is my understanding that when the appropriations committee meets they make their appropriations in accordance with the categories; is that correct? Dr. TERRY. Yes, sir. Mr. SPRINGER. Now, what you have attempted to do in chart 3, as I understand it, is that instead of setting these up by categories such as heart, cancer, and so forth, you have now tried to set them up under the functions which you actually have in NIH; is that correct? Dr. TERRY. That is a correct statement. Mr. SPRINGER. In the left-hand column, for the purpose of identification, is the number of millions of dollars which are spent in these various NIH functions and components; is that a correct statement? Dr. TERRY. That is a correct statement. Mr. SPRINGER. Now go down to the middle of the page in the box which is enclosed with the black border. The regular research projects are listed at $408 million. Dr. TERRY. Yes, sir. Mr. SPRINGER. This would be roughly half of your entire budget; is that correct? Dr. TERRY. Of the NIH? Mr. SPRINGER. Yes. Dr. TERRY. Yes, sir. Mr. SPRINGER. What was your total budget for 1963, just roughly? Dr. HUNDLEY. $930 million. Mr. SPRINGER. $408 million as against $930 million. Do you believe that for the future it would be better for identification purposes for Members of Congress to have your appropriation set up under functions and components rather than categories? Dr. TERRY. No, sir; I do not. Since it was available to the committee in the other form as a standard portion of the appropriation documents and in the background committee print, we merely wish to portray it in this manner because this form is not readily available in the other materials. No, sir. I do not think that this would be better. Mr. SPRINGER. Dr. Terry, the part that was revealing to me in having this chart before me, in these instances that you have set up under the boards in chart 1, I have to go through all of those to find out how much you are doing in research, for instance. I do want to know how much goes to research and this gives me a much better picture from a practical standpoint than it does to search through each one of these and determine how much research goes into each one of them. This is very revealing to know you have $408 million in research, roughly, plus your eight centers, international centers, and your general research support. This gives me a pretty clear picture of what you are doing. I may be wrong about this, but I think it would be much more to your advantage to have it done in this way, although I will admit that the question of cancer and heart has some popular appeal. But in order to know what you are doing, when these things come before a Congressman, to have it in this form gives a better picture of how much you are actually doing in the form of research. Do you have any comments? Dr. TERRY. Mr. Springer, I would like to call your attention to the chart that we presented to you within the past 2 days which shows a breakdown of the appropriations. For instance, it takes each Institute and shows how much of the total funds for that Institute went into research grants, how much went into fellowships, how much went into training; and then, over in the area of direct operation, what the individual or various costs were there. So, what we have attempted to do is to present information in various ways to give you an overall perspective so that you could look at it in terms of category or in terms of the sort of functional chart that we have just been discussing. Mr. SPRINGER. Mr. Chairman, that is all. Mr. ROBERTS. I thank the gentleman from Illinois. Thank you, Dr. Terry, and your associates, for the exhaustive presentation which you have made of the numerous health programs administered by the Public Health Service. The members of the committee and the staff will analyze the material carefully. The Chair will call further hearings at a later date on different aspects of these proposals. In closing the public health phase of the hearings, let me say that I, for one, feel that it may be necessary to stagger the exploration dates of these programs so that the committee will have opportunity to scrutinize the programs at regular intervals. Again, I want to express the sentiment of the subcommittee in thanking you and your associates for what I think has been a very clear presentation. Dr. TERRY. Thank you, Mr. Chairman, and members of the committee. It has been a pleasure for us to appear because we realize that the very life of our programs depends upon the proper understanding of our programs by the Congress and particularly, of course, on our legislative committee of the Congress. Mr. ROBERTS. Mr. Rogers. Mr. ROGERS of Florida. I just wanted to ask Mr. Pond on item 2 that he might supply some information for the record for us perhaps. I notice that on page 4 of your statement you say: For many health occupations there has been no comprehensive study of manpower needs and training requirements. Such a study could provide a real incentive to the orderly development of training capacity. Then on page 5 you say: In the past few years major studies have been made of needs of medicine. dentistry, nursing, environmental health, mental health services, and research. Now, I think it might be well for us to know what areas you feel need study, particularly, and what is being done to bring about these studies or what should be done as far as legislation is concerned. Also, I would like to know if you can give the committee information as to how we are meeting the needs of the studies that have been made in medicine, in dentistry, and in nursing because I know some of the programs that we have passed previously have been geared to the solution of this increased need for nursing, and so forth. If you could, tell or project for the committee how these programs are helping to solve the need and in what magnitude they are doing it or whether we are failing to meet the needs of the projected study. For instance, in nursing or in all of the programs that you are administering. Mr. POND. Mr. Rogers, I will do my best to supply that information for the record. (The information mentioned follows:) HEALTH AMENDMENTS ACT OF 1956 (PUBLIC LAW 84-911) A 3-year professional nurse traineeship program was established in August 1956 under title II of this act. In 1959 the program was extended to June 30, 1964. This act provides for long-term traineeships to increase the number of graduate nurses prepared for positions as administrators, supervisors, and teachers in all fields of nursing. A short-term training program was added in fiscal year 1960, designed to update management and teaching skills in nursing. Total funds appropriated, 1957–62. Number of long-term trainees, 1957–62--Number of short-term trainees, 1960-62-- $29, 989, 500 9, 029 9,970 A 3-year public health traineeship program was established under title I of this act. In 1959, the program was extended 5 years. The program's objective is to increase the number of trained public health personnel, with primary emphasis on needs of public health agencies for professional workers with a year or more of postprofessional academic public health work. Total funds appropriated, 1957-62- $10, 974, 000 4, 241 PUBLIC LAW 85-544, GRANTS TO SCHOOLS OF PUBLIC HEALTH FOR PUBLIC HEALTH TRAINING Section 314 (c) authorizes appropriation of not to exceed $2,500,000 annually for grants-in-aid to schools of public health for provision of comprehensive professional training and other services. There are 12 schools of public health accredited by the APHA for the granting of degree of masters of public health. These are the only institutions which meet the legal qualifications of this law. In allocating funds among the schools the Surgeon General is required to "give primary consideration to the number of federally sponsored students attending each such school." Total appropriations, 1959–62--- $3,623, 000 2, 326, 008 DENTAL STUDENT TRAINING Under authority of section 422(f) of the Public Health Service Act, training grants are made to dental schools for the operational costs of training dental students in the use of auxiliary personnel. These grants must be approved by the National Advisory Dental Research Council. Forty-four of the Nation's 48 dental schools participate in the program, training approximately 3,500 selected junior and senior dental students. Funds, fiscal year 1963. $1,826, 000 NATIONAL INSTITUTE OF MENTAL HEALTH TRAINING GRANTS This program was established in 1947. NIMH training grants in the form of teaching grants and grants for trainee stipends are awarded to develop and strengthen programs in the broad spectrum of mental health training. Specific areas of training include graduate and undergraduate training in psychiatry, clinical and other psychology, psychiatric social work, psychiatric nursing, and social and biological sciences related to human behavior and mental health. Number of trainee stipends awarded, fiscal year 1962–. Amount of trainee stipend awards, fiscal year 1962- 5,402 $17,939, 419 21, 435, 556 39, 374, 975 Total amount of training awards, fiscal year 1962. Further information on training programs is contained in the committee print, "Background Material Concerning the Mission and Organization of the Public Health Service," pages 94-100 and 114-116. These programs have accomplished a great deal in meeting certain specialized health manpower needs. In accordance with the law, conferences have been called for this summer to appraise the effectiveness and make recommendations with respect to the traineeship programs under sections 306 and 307. The conference considering public health traineeships will also review the program of grants to schools of public health. Reports of these conferences are by law to be submitted to the Congress by January 1, 1964. The overall review of requirements which we plan will help to set the achievements of these ongoing programs into the total framework of need. Mr. POND. The point I made on the first page of my prepared statement was that we have good information on a few of the professional and major categories, but there are numerous other types of manpower about which we know very, very little. I did, with the committee's permission, insert into the record a tabulation of these very different categories. As you see this information, you will realize how little we really do know. My plea really was for a total manpower review, to look at the whole problem of health manpower and not just pick off category by cate gory. (The following was submitted in reference to the above:) Studies made in the past few years in medicine, dentistry, nursing, and certain other fields have laid the foundations on which the Public Health Service has been able to develop and support such recommendation as those upon which H.R. 12 was based. However, various of these studies have raised questions about the relationship of manpower needs in the professional field under review to the broad range of health manpower resources and requirements. For example, the committee recommending Federal aid for medical education in 1959 commented: "The charge to this consultant group was to consider the needs in the field of medical education. It is necessary, however, to associate the problems of medicine with those of the related health professions. Physicians cannot carry their load of responsibility without competent and well-trained teammates and associates. "There is increasing recognition of the interrelated responsibility of health workers with a variety of skills and educational preparations. One evidence of this is the development of university-based health centers with closely related schools of medicine, dentistry, nursing, and other health professions. * * * The growth of the allied health professions has had profound effects on the patterns and availability of medical care. In 1900, for every physician in practice there |