Mr. BROTZMAN. The point is, when you talk about filling up the pipeline, it does not necessarily insure that it is going to solve the problem that I understand this bill is striking at. Neither do I think the Federal Government can tell a doctor where he should go practice his particular profession. But it would be very helpful to me, I know, if I were able to see something on a national basis demonstrating this particular point. It would help me to assess the value of this particular piece of legislation. Dr. NELSON. Mr. Brotzman, we will get you copies of these studies through our association offices if you cannot get them in any other way. Mr. BROTZMAN. Would you do that? Dr. NELSON. Yes, sir. Mr. BROTZMAN. I have one more question. From your testimony, and I notice in your statement, you say that you endorse this House bill No. 12. Dr. NELSON. Yes, sir. Mr. BROTZMAN. Now, when you make that statement, I assume you endorse it in its present form; is that correct? Dr. NELSON. No, sir. I urge that you include the hospital schools of nursing in that section. Mr. BROTZMAN. I understand that one exception. Now, there is one other feature here that I wanted to ask you about, that is, if your association had studied the need factor. Just turning to the bill for a moment, you will notice that this encompasses more than just doctors and nurses, and I think you also made some statement relative to public health personnel. Dr. NELSON. I did. Mr. BROTZMAN. Do you have an opinion relative to the need for these facilities for training pharmacists? Dr. NELSON. No. I am not well versed in that, but I can give you an opinion from the hospital field that there is nothing like the shortage of pharmacists as we are talking about in nurses and doctors. That is a personal opinion. Mr. BROTZMAN. And how about optometrists? Dr. NELSON. I have had very little experience with that. Mr. BROTZMAN. Podiatrists? Dr. NELSON. Very little experience with that. Mr. BROTZMAN. So, then, your testimony as to the need factor, basically, pertains to doctors, nurses, and you had some testimony as to professional public health personnel; is that right? Dr. NELSON. Yes, sir; it does. Mr. BROTZMAN. Thank you. The CHAIRMAN. Anything further, Mr. Brotzman? Mr. BROTZMAN. That is all. Thank you, Mr. Chairman. Mr. LONG. Dr. Nelson, those of us from rural areas are particularly concerned with the aggravated problem in such areas. Are you familiar with the provisions of this bill that would provide an incentive to doctors participating in the program either settling in areas of that type and practicing in areas of that type or participating in certain facets of the medical practice? Dr. NELSON. I would have to examine that in detail, sir. Mr. LONG. What it provides, speaking in general, is cancellation, at the rate of 10 percent per year, up to 50 percent of unpaid principal and interest in the event these doctors who have participated under the program take a particular course of action. Dr. NELSON. Yes, I understand now. I am familiar with the provision. Mr. LONG. This is designed to alleviate this problem, this very critical problem, in rural areas. Dr. NELSON. Yes. Mr. LONG. Do you feel that this is going to be effective? Dr. NELSON. It is a hard judgment to make, whether a student would take a less desirable place, for a 10-percent rebate. Well, it might help some. That is about the best answer I can give you. It might help some. Mr. LONG. Your association, in making a determination they were in favor of this bill, was this done by committee? Dr. NELSON. Yes. We have a series of committees and councils heading up to the board of trustees of the association. They have not approved the specific wording of this testimony, but, arrival at a position of support, followed generally by the bill. Mr. LONG. But, in general, the committees of your organization that looked into this matter and the board of your organization that looked into this matter do feel that both aspects of this legislation are legitimate areas for Federal activity and Federal participation? Dr. NELSON. Yes, sir. Mr. LONG. Thank you. Thank you, Mr. Chairman. The CHAIRMAN. Doctor, I think every member of the committee appreciates your statement as to the need for nursing personnel, and I would like to comment I do not know what is going to happen in this country with respect to nursing, as well as other things, if the cost continues to go up, which it is doing. In my judgment, that is primarily owing to the extreme shortage of nurses. It is not a reflection on anyone. It is just a fact. It is like the impact on the economy which causes inflation. You get a shortage where demand exceeds the supply. This is what you experience. I do not know what the committee will do this year, but it decided last year that this was a problem that ought to be considered separately, generally speaking. There is a report coming out on this problem, and we are waiting for it. So, unless the committee decides otherwise, it would be proper to suppose that we should have more information on it than is available at the present time. Dr. NELSON. Mr. Chairman, could I express a hope that, when you separately consider nursing, that the hospital and collegiate nursing schools be considered together, and that construction of facilities be included in that consideration. The CHAIRMAN. I am sure the entire problem will be considered. We did consider that in connection with the Hill-Burton program. We are going to have to extend it—that is, if the program is to be continued, it will have to be extended-sometime during this year and certainly by next year, and that would be an excellent opportunity to discuss this entire problem. But I did want to let you know that that is the situation as it now stands. Let me, on behalf of the committee, thank you for your appearance here and for your testimony. Dr. NELSON. Thank you for the opportunity, sir. The CHAIRMAN. Dr. James P. Hollers. Dr. Hollers, you are representing the American Dental Association and are from San Antonio, Tex. I believe you have with you Dr. John Brauer, chairman of the legislative committee of your national association, who is dean of the Dental School of the University of North Carolina. We are very glad to have both of you gentlemen, and we will be glad to have your presentation. STATEMENT OF DR. JAMES P. HOLLERS, PRESIDENT-ELECT, AMERICAN DENTAL ASSOCIATION, ACCOMPANIED BY DR. JOHN BRAUER, CHAIRMAN, COMMITTEE ON LEGISLATION, AMERICAN DENTAL ASSOCIATION, AND DEAN OF THE DENTAL SCHOOL OF THE UNIVERSITY OF NORTH CAROLINA, AND BERNARD J. CONWAY Dr. HOLLERS. Mr. Chairman and members of the committee, I am Dr. James P. Hollers, a private practitioner of San Antonio, Tex., and president-elect of the American Dental Association. The American Dental Association represents 85 percent of the 100,000 practicing dentists in this country. With me is Dr. John C. Brauer, who is chairman of the Committee on Legislation of the American Association of Dental Schools and dean of the School of Dentistry at the University of North Carolina. I am also accompanied by Mr. Bernard J. Conway of Chicago, Ill., who is in charge of the American Dental Association's legal and legislative affairs. We are here today to present the views of the American Dental Association and the American Association of Dental Schools on H.R. 12, the Health Professions Educational Assistance Act of 1963. Last year representatives of the American Dental Association and the American Association of Dental Schools appeared separately before this committee to testify in support of H.R. 4999. This year, in the interest of conserving the valuable time of this committee, Dr. Brauer and I are appearing together and will present brief oral statements representing the views of both associations. The committee last year compiled an extensive and comprehensive record on the need for legislation to assist in supplying the professional health personnel that will be needed to care for the people of this country in the future. We hope, and it is our understanding, that the facts and figures that were presented to the committee last year will be incorporated by reference into the record of these hearings and that such information will be used by the committee in its deliberations. The American Dental Association and the American Association of Dental Schools support wholeheartedly the approach taken in H.R. 12. The bill is aimed at relieving what is probably the most critical problem in the health field today-the impending shortage of health personnel. It is believed that the bill's provisions for assistance in the form of matching grants for construction and remodeling of dental teaching facilities and for low-interest loans to dental students will provide a powerful stimulus toward accomplishing the ultimate objective of assuring the quantity and quality of dental care that our rapidly expanding and increasingly health-conscious American public demands and expects. Look briefly at the scope of the dental health problem in this country today. DENTAL DISEASE: ITS SCOPE AND SERIOUSNESS Almost 160 million of the 185 million people in the United States have dental disease or face the certain prospect of suffering from tooth decay, periodontal (gum) disease, oral cancer, malocclusion or cleft lip and palate. The best estimates are that 97 percent of the people have tooth decay; 23 million have periodontal disease; 21 million persons are without teeth; 16 million have malocclusion; 65,000 children under 18 have cleft palate, cleft lip, or both. Twenty-three thousand persons develop oral cancer each year. It is estimated that 85 million man-hours of industrial production are lost annually owing to oral disease. The population of this country is increasing sharply. As it does, so does the size of its already burdensome health problem. Something must be done now if we are to have any chance at all of maintaining even the status quo. Unless we have a substantial increase in the number of dental graduates-nearly doubling the present number-the present ratio of dentists to population will not be maintained in the year 1975. Experts on population growth have predicted that by 1975 the population of the United States will be 235 million. At the same time, the segment of the population under 15 years of age will have increased 35 percent over its present proportion. To the dental profession, this is a disturbing, even alarming, fact. It suggests that a decade or so in the future, we may be less successful in controlling dental disease than we are today. In the long run, dental disease can only be brought under reasonable control through preventive means; it can never be done completely through restorative techniques. Indeed, it is the obvious superiority of preventive care over restorative care that leads the dental profession to lay such great stress on proper oral hygiene in the home, proper diets, dental health education in the schools, regular checkups, and the implementation of such public health measures as fluoridation. With today's ratio of dentists to population, it is difficult enough to practice preventive care to the degree every practitioner would desire. But what can we think when looking forward to a time when the population will have grown greatly while the number of dentists remains stable; when rising education levels will have brought an increased appreciation of the need for regular dental care; and when a larger percentage of the population is composed of youngsters below the age of 15? Under such circumstances, the task of restoring already diseased tissues would be formidable. Indeed, I wonder if we could maintain the present level of dental health. And I fear that the practice of preventive dentistry would be severely limited. TEACHING FACILITIES: A TOP PRIORITY Obviously, the solution to the dental health problem is dependent upon a supply of professional dental personnel. The top priority in dental education is for construction or bricks-and-mortar money to build new facilities and to renovate existing obsolete dental teaching facilities. At present, we are graduating about 3,300 dental students per year. Based upon projected population estimates, we will need 6,200 graduates by 1975 in order to maintain the 1959 ratio of dentists to population. A 1961 survey conducted by the American Dental Association and the American Association of Dental Schools 1 indicates that there are plans to initiate dental teaching facility construction involving about $70 million in the next 10 years. In the same survey, the schools reported that if matching funds were available, they would be able to fulfill their part in a building program of approximately $350 million. The association believes that the matching-grants formulas as set forth in H.R. 12 are realistic and the full authorization for dental school construction and renovation would be fully utilized. STUDENTS: THEIR FINANCIAL NEEDS Next to the need for construction funds is the need to help students bear the financial burden of a dental education. The average cost to students of a 4-year dental education is about $15,000, and the existing sources of financial aid for students are relatively few. The American Dental Association, through the fund for dental education, has granted within the last 3 years $200,000 for loans to dental students. There also is some help available under the National Defense Education Act. But it is much too little. The fact is that because of the high cost of obtaining a dental education, the profession of dentistry remains closed to many qualified young people. If the standards of health in this country are to continue to be improved, some way must be found to let such needy young people pursue careers in the health professions. The loan provisions of H.R. 12 would assist greatly at filling the gap that now exists. H.R. 12 also should alleviate to some extent the problem of unrealistic distribution of health personnel. This would result from the provisions for canceling a portion of the loan of the graduates practicing in a shortage area. This incentive should be of substantial benefit to people who do not now have access to adequate health care without traveling unreasonable distances to receive it. In this connection, the construction grant program itself also should be of benefit, since experience has demonstrated that a substantial proportion of dental graduates tends to establish practices in the 1 "Survey of Financial Aid for Dental Education," 1961, Council on Dental Education, American Dental Association; and American Association of Dental Schools. 94933-63-12 |