HEALTH PROFESSIONS EDUCATIONAL ASSISTANCE THURSDAY, FEBRUARY 7, 1963 HOUSE OF REPRESENTATIVES, The committee met, pursuant to recess, at 10 a.m., in room 1334, New House Office Building, Hon. Oren Harris (chairman) presiding. The CHAIRMAN. The committee will come to order. This morning our first witness will be Dr. Gerald D. Dorman, member of the board of trustees of the American Medical Association. Doctor, we are very glad to have you with us. I observe that Dr. McKittrick, chairman of your council on medical education and hospitals, is here with you and will be with you during your presentation. I also believe you have with you today Walter Wiggins, who is secretary of the council. We are very glad to have both Dr. McKittrick and Dr. Wiggins here with you this morning. I believe there are three chairs there. Will you be seated as you desire. You may proceed. STATEMENT OF DR. GERALD D. DORMAN, MEMBER OF THE BOARD OF TRUSTEES OF THE AMERICAN MEDICAL ASSOCIATION, ACCOMPANIED BY DR. LELAND S. McKITTRICK, CHAIRMAN, COUNCIL ON MEDICAL EDUCATION AND HOSPITALS, AND DR. WALTER S. WIGGINS, SECRETARY OF THE COUNCIL Dr. DORMAN. Mr. Chairman and members of the committee, I am Dr. Gerald D. Dorman, of New York City. I am appearing here today as a member of the board of trustees of the American Medical Association. Accompanying me are Dr. Leland S. McKittrick, chairman of the American Medical Association's Council on Medical Education and Hospitals; and Dr. Walter S. Wiggins, secretary of the council. The American Medical Association is a national association of approximately 200,000 physicians. The association, since its inception in 1847, has continuously worked toward increasing the number of qualified physicians. Since 1940, the association, in collaboration with the Association of American Medical Colleges, has aided interested organizations in the establishment of 12 new medical schools. Currently, commitments have been obtained for another five schools and we are in consultation with more than a dozen institutions or organizations presently contemplating the establishment of new medical schools. The American Medical Association has a serious interest of long standing in maintaining the high quality of medical education in thể United States, without which there cannot be high-quality medical care. For over a century, the American Medical Association has been actively and effectively engaged in the improvement of medical education. It can now be said, with assurance, that medical education in this country is superior to that found anywhere else in the world. It is not a coincidence that improved standards of medical care in the last half century saw the elimination of substandard medical schools and "diploma mills" which had been turning out graduates in large numbers. This improvement in medical education is the direct result of the vigorous efforts of this association and other interested organizations. Recognizing the problem in the field of medical education, the American Medical Association for the past several years has endorsed a limited Federal program of aid to medical schools. In June of 1955, the American Medical Association supported the medical school construction provisions contained in H.R. 4743, 84th Congress, introduced by the late chairman of this committee, Mr. Priest of Tennessee. In April of 1958, the association favored the construction provisions of H.R. 6874, 85th Congress, introduced by the committee's current chairman, Mr. Harris. Again in June 1960, the association supported the construction provisions of H.R. 6906, 86th Congress, introduced by Mr. Fogarty of Rhode Island. Just last year, I had the opportunity to appear before this committee speaking on behalf of the AMA, urging passage of that portion of H.R. 4999, 87th Congress, designed to authorize matching grants for the construction, replacement, or rehabilitation of medical schools, which was introduced by Mr. Harris. I should like to take this opportunity on behalf of the American Medical Association to respectfully submit for your consideration our views on certain provisions of H.R. 12, 88th Congress, which is now pending before your committee. It is our understanding that this bill would amend the Public Health Service Act to provide: (1) Matching grants for the construction, replacement, or rehabilitation of medical, dental, and osteopathic schools, and for schools providing training in ancillary services. (2) Appropriation of sums to establish a loan fund for medical, dental, and osteopathic students. (3) Expansion of the research facilities construction program. I shall limit my discussion to those sections of the bill providing for matching grants for the construction, replacement, or rehabilitation of medical schools. If the high standards of medical education are to be maintained, increased attention must be given to the adequacy of physical facilities, the availability of qualified instructors, and the availability of teaching material and patients for the clinical phases of medical education. Any attempt to increase the number of medical students without regard to these conditions will result in a lowering of the standards of medical education. At this time, priority should be given, in our opinion, to an increase and improvement in the physical facilities available for medical education. We believe that there is need for assistance in the expansion, construction, and remodeling of the physical facilities of medical schools and, therefore, a one-time expenditure of Federal funds on a matching basis is justified, where maximum freedom of the school from Federal control is assured. The support by the AMA of these provisions in H.R. 12, 88th Congress, is based on the action of our house of delegates taken initially in June 1951, and reaffirmed frequently since that time. We would also urge that the National Advisory Council on Education for Health Professions, suggested in the bill, be composed of persons skilled in the broad aspects of engineering, education, finance, architecture, as well as those concerned with training in medicine, osteopathy, dentistry, or the other named ancillary services. When I appeared before this committee on January 26, 1962, to present the comments of the American Medical Association on H.R. 4999, 87th Congress, the predecessor of H.R. 12, I referred briefly to the AMA's student loan program. At that time the program was still in the final planning stages, and Dr. McKittrick, Dr. Wiggins, and I, in response to the committee's questions, were able only to estimate the probable effect of the project. As of December 31, 1962, the program had been in effect only 10 months; however, we can now transform the estimates into actual data. We believe these initial results to be dramatic. The American Medical Association Education and Research Foundation has prepared two brochures which may be of significant interest to the members of this committee. I ask that these, one entitled "Medical Education Loan Guarantee Program," and the other a "Progress Report Through December 31, 1962," be received and incorporated in the record of these proceedings. The AMA's medical education loan guarantee program, designed to alleviate the financial difficulties of medical students and to encourage career decisions in favor of medicine, utilizes the principle of a security fund, functioning as a surety agency, to make available unsecured personal loans at a relatively low rate of interest to medical students, interns, and residents. Administrative costs are paid by the American Medical Association-Education and Research Foundation. The loans, which have been available since March of last year to medical students, interns, and residents, provide each borrower with as much as $10,000 over a 7-year borrowing period. The growth and success of the AMA-ERF medical education loan guarantee program can be best described as phenomenal. In the 10 short months since it was initiated, nearly 1 in every 10 medical students in the country now has borrowed money under this program. Through December 31, 1962, a total of 4,694 individuals (2,890 medical students, 672 interns, 1,132 residents) received 5,299 loans or $6,111,400 in principal amount. Ten percent of the borrowers applied for and received more than one loan. The borrowers are in training in 83 medical schools and 462 hospitals in 46 States and possessions. 94933 0-63-17 Through the end of last year, 6.8 percent of the loan applications received had to be rejected, for the most part because the applicants indicated that they needed funds for consumer items such as cars and furniture, and not for essential education and living expenses. No one has been refused because of lack of money in the guarantee fund. Although almost one-third of the borrowers come from families where the father is deceased, disabled, or retired, we find at the other end of the scale that a similar number have fathers who are executive, professional people, and owners of small businesses. The guarantee fund consists of contributions from individual physicians, medical societies and private industry. Although the fund contains more than $1 million and its uncommitted balance at the end of the year was sufficient to permit the granting of an additional 1,200 loans, our efforts toward increasing the fund continue so that we may meet the anticipated volume of loan requests. Each dollar that is contributed to the AMA-ERF program is worth 1212 times its value in loan power. Private banks have contracted with the American Medical Association-Education and Research Foundation to provide money for the loans. Under the agreement, the banks will extend $1,250 in credit for each $100 deposit in the fund. This program has been adopted with the firm conviction that if it is implemented with wisdom and vigor, the quantity and quality of medical schools' applicants will be increased and enhanced. The performance of many medical students will be improved by the alleviation of their financial problems and the profession will thereby demonstrate a significant acknowledgment of medicine's obligation in this area. It is logical to assume that further improvement in medical care will ultimately result from this immediate positive action. In summary, the American Medical Association, by its own action, has given clear recognition to the financial problems of medical students, interns, and residents. This AMA-ERF program indicates the extent to which private enterprise and efforts can solve important problems without the necessity of calling on the Federal Government for tax funds. We are firmly convinced that governmental assistance to medical education should give first priority to providing necessary, needed funds for medical school construction. The American Medical Association wishes to thank you for giving us this opportunity to express the views of the physicians of America concerning certain provisions of this important legislation. Dr. McKittrick, Dr. Wiggins, and I will now be most pleased to attempt to answer any questions that the committee may have. The CHAIRMAN. Thank you very much, Dr. Dorman, for your statement on behalf of the American Medical Association. Your request that the information you have submitted be included in the record, I think, is appropriate, and will be included at this point. There may be a printing problem with reference to some of the charts, but we will see what we can do about it. Dr. DORMAN. Thank you, Mr. Chairman. (The booklets referred to follow :) |