the National Commission on Accrediting; and Dr. I. L. Baldwin, Ph.D., formerly vice president, presently assistant to the president, of the University of Wisconsin; and Lloyd E. Blauch on my left here, formerly United States Assistant Commissioner for Higher Education, presently assistant director of the Retired Professors Registry; George E. Gensler, D.S.C., past president of the American Podiatry Association, formerly member of its council on education; and Leland Powers, M.D., who was here before you today with another group, associate director of the Association of American Medical Colleges. These gentlemen prepared a report through the efforts of their special commission, and at one point here state that: "The American Podiatry Association should represent to the appropriate legislative and executive officials of the Government the need and social advisability of making financial provisions for podiatry education in ways similar to those made for the other health sciences." You gentlemen have seen fit to do this sort of thing. Mr. ROGERS of Texas. How many podiatrists are there in the United States? Dr. YALE. There are approximately 8,000. I believe Dr. Rubin can answer the statistical questions a little better than I. Dr. RUBIN. About 8,300 graduates still living around the United States, about 7,600 of them in active practice. Mr. ROGERS of Texas. How much money do you think would be required of the Federal Government to meet this need, just approximately? Dr. RUBIN. Our rough estimate was it would be about 1 percent of the total authorization, about $750,000. Mr. ROGERS of Texas. Thank you, Mr. Chairman, that is all. Mr. O'BRIEN. I would like to ask just one. The CHAIRMAN. Mr. O'Brien. Mr. O'BRIEN. Where are your four colleges located, Doctor? Dr. YALE. We have one college in New York City; a new proposed college with a charter in Philadelphia; a college in Cleveland; one in Chicago, and one in San Francisco. Mr. O'BRIEN. None in Texas? Dr. YALE. No, and we are trying to interest Texas. Mr. O'BRIEN. I was quite impressed with your figures here. You have one podiatrist for every 10,000 in New York and one for every 68,000 in Texas. With the boots they wear out there, I would think the need would be much greater in Texas. Mr. KORNEGAY. They ride horses out there. Mr. O'BRIEN. That is all, Mr. Chairman. Mr. ROGERS of Texas. If the gentleman will yield, the Chairman tells me that they treat heels, too. [Laughter.] The CHAIRMAN. Any further questions? Mr. Broyhill. Mr. BROYHILL. Mr. Chairman, just one thing here. In his testimony the doctor indicated that of the four colleges, that two of the colleges had a capacity enrollment in the first-year class, and that one other approached this, and I assume, then, that the other college had openings, then? Dr. YALE. Yes, they did. Mr. BROYHILL. In the first-year class. Then you also indicated that in the past few years you have had an increase in enrollment in the first-year classes. Does this mean that you do not have students applying for these positions? Do you see what I mean? Do you have positions open but do not have students applying for them? Dr. YALE. Well, you must recognize that in our profession, as in all medical professions, I presume, that we are selective to a degree; that we also are suffering with the problem that medicine suffers with, and dentistry as well, where the A students are not applying to our institutions. However, we have a very interesting arrangement that has developed in the last few years in our profession that is primarily based on the impetus given to us by the Seldon report just mentioned here, wherein we have increased our educational qualifications, preeducational qualification for the study of podiatry, and we are today getting a quality of student that is so much higher than what we had dreamed of some 20 years ago; that we find it necessary, in order to meet the requirements of these students, to upgrade our physical facilities, and, as pointed out by the Seldon Commission, they state here: The physical plant facilities require renovation and improvement. Equipment needs to be added or replaced. There are heavy requirements for additional laboratories and research space, construction of new outpatient clinics and larger libraries. There will also be an eventual demand for more schools. This gentlemen, is why we come before you. As to why there are vacancies in schools, this becomes a local problem at times. There are medical schools in this country where vacancies do exist. We are aware of this. The same thing in dental shools. But, yet, there are other dental schools and medical schools which are so overwhelmed with applicants they could not possibly educate them. Mr. BROYHILL. I have no further questions, Mr. Chairman. Mr. Rhodes. Mr. RHODES. Mr. Chairman, I would like to ask Dr. Yale if the colleges of podiatry are accredited schools? Dr. YALE. Yes. The colleges of podiatry are accredited through the accrediting agency, which is the Council on Education of the Amerian Podiatry Association, and this accrediting agency is accepted as the accrediting agency by the Commissioner of Education of the U.S. Department of Health, Education, and Welfare as the accrediting agency for podiatry schools. Mr. RHODES. To what extent is your profession able to take care of the needs of these training schools? Dr. YALE. Are you now referring to our ability to maintain the institutions? Mr. RHODES. Yes. Dr. YALE. From a facilities standpoint or constructional? Mr. RHODES. School facilities. Dr. YALE. I might say this, and I did read this into the record, a statement to the effect that we had endeavored to advise you last year of how the profession was attempting to meet an otherwise unmet health need, some information about the needs of our schools and what we podiatrists are doing to help meet these needs. Our members, through their dues structure, are now making almost $100,000 available annually through matching grants, and these funds are earmarked for instructional and research personnel. In addition, the Fund for the Advance of Podiatry Education has stimulated the giving by alumni and friends of our schools of more than $250,000 in its first 3 years of operation. Mr. RHODES. Thank you, doctor. The CHAIRMAN. Doctor, thank you very much. The CHAIRMAN. This concludes the hearings on these bills. The record will remain open for 5 days for anyone to submit statements which could be appropriately included in this record. Before we adjourn, I do wish to include in the record the special message which was received today from the President of the United States on health. (The special message referred to follows:) SPECIAL MESSAGE ON IMPROVING AMERICAN HEALTH To the Congress of the United States: THE WHITE HOUSE, February 7, 1963. Health, as Emerson said, is the "first wealth." This Nation has built an impressive health record. Life expectancy has been increased by more than 20 years since 1900; infant mortality rates have been dramatically reduced; many communicable diseases have been practically eliminated. We have developed or are close to developing the means for controlling many others. The intensive medical research effort begun shortly after World War II is now showing dramatic results. The array of modern drugs, appliances, and techniques available to prevent and cure disease is impressive in scope and in quality. But each improvement raises our horizons; each success enables us to concentrate more on the remaining dangers, and on new challenges and threats to health. Some of these new challenges result from our changing environment, some from new habits and activities. More people than ever before are in those vulnerable age groups-the very young and the very old-which need the greatest amount of health services. More people are living in huge metropolitan and industrial complexes, where they face a host of new problems in achieving safety even in the common environmental element of food, water, land, and air. The hazards of modern living also raise new problems of psychological stability. In addition to the long-neglected problems of mental illness and mental retardation on which I made recommendations earlier this week, other areas affecting our Nation's health also require serious and sustained attention: There is a shortage of professional health personnel. We must take prompt and vigorous action not only to increase the numbers of trained personnel but to perfect better means for making the most effective use of the health manpower now available. Health facilities must be improved and modernized. More of them need to be geared to the problems of older and long-term patients. Health care is not adequately available to our older citizens. Costs to aged individuals too often are prohibitively high, and we have not yet been effectively able to bring modern health services to many of them. Threats to the physical well-being of our families from the contamination of food, air, and water, and from hazardous drugs and cosmetics, must be dealt with more promptly and more effectively. Health protection and care must be made more widely available to our children, particularly those whose parents cannot afford proper care and those who are suffering from crippling diseases. In each of these key areas, this Nation has an obligation to strengthen its resources and services. The alternative is a weaker people and nation, a waste of manpower and funds, and a denial to millions of people of a full and equal opportunity to life, liberty, and the pursuit of happiness. The Federal Government has stimulated much of the recent progress in medical research without any interference with scientific, academic, or individual liberty. Our task now is to be equally decisive in putting this knowledge into practice. Financial provision for the recommendations made in this message was included in the 1964 budget which I transmitted to the Congress last month. I. PROFESSIONAL HEALTH PERSONNEL Perhaps the most threatening breach in our health defenses is the shortage of trained health manpower. Our health can be no better than the knowledge and skills of the physicians, dentists, nurses, and others to whom we entrust it. It is essential that we always have a sufficient supply of such talent, drawn from the best and most gifted men and women in the land. But the harsh fact of the matter is that we are already hard hit by a critical shortage in our supply of professional health personnel, with the situation threatening to become even more critical in the years immediately ahead. Our hospitals report substantial numbers of unfilled positions for nurses and other health workers. In some cases, entire wings or floors have been closed for lack of trained personnel. In others-particularly mental hospitals, where thousands of patients languish in needless confinement and suffering due to a lack of doctors and nurses-the unavailability of sufficient personnel is a reluctantly accepted fact. A. Medical and dental education The shortage of physicians and dentists is particularly serious. Our medical and dental schools do not graduate enough students to keep pace with our growth in population. There are 137 physicians and 56 dentists for every 100,000 American people in the country today. And merely to maintain even this ratio will require, over the next 10 years, a 50 percent increase in the number of graduates from our medical schools and a 100 percent increase in the number of dental graduates. In an effort to meet present needs, we now license more than 1,500 graduates of foreign medical schools each year to practice in this country-approximately one-fifth of the annual additions to our medical profession. In addition, one quarter of the interns and residents in our hospitals are foreign medical graduates. Yet many internships and residencies remain vacant due to lack of manpower. More and more physicians are devoting their time to teaching, to research, to advanced preparation in a speciality; and while this trend represents progress, it also decreases the proportionate supply of physicians available to treat our families. In 1950, there were 1,300 people in the United States for each family physician. The present outlook-unless steps are taken now to increase the supply of physicians-is for more than 2,000 people per family physician by 1970. Therefore, I again urgently recommend enactment of legislation authorizing (1) Federal matching grants for the construction of new, and the expansion or rehabilitation of existing, teaching facilities for the medical, dental, and other health professions; and (2) Federal financial assistance for students of medicine, dentistry, and osteopathy. B. Nurses' training There were 550,000 professional nurses and 225,000 practical nurses in active practice in 1962. This number is far too small to meet the needs of high quality nursing care. Too many hospitals have been required to rely on inadequately trained orderlies and attendants. At my request, a distinguished group of citizens, serving as consultants to the Surgeon General, has studied the scope and solutions of this problem. They concluded that a feasible and essential goal for 1970 is to increase the number of professional nurses in practice to some 680,000 and the number of practical nurses to 350,000. This requires a 25-percent increase in the supply of nursing personnel and, therefore, a major expansion in both collegiate and hospital programs of nursing education. The number of nurses graduating from collegiate courses would have to double from 4,000 in 1960 to at least 8,000 in 1970. This expansion would require the equivalent of more than 30 to 35 new collegiate nursing schools. Graduates from hospital schools would have to increase from 25,000 to 40,000 by 1970, and junior colleges would have to be graduating 5,000 by that year. Nursing schools are unable to bear the tremendous financial burden for an expanded effort of this size. Despite diligent effort, nursing has had little success in commanding sufficient local support for the development of its edu cational facilities and programs. Federal assistance in the expansion of our capacity to train nurses will be necessary. To meet these goals, and generally to improve the quality of nursing services, the consultant group recommended that the Federal Government: (1) provide financial assistance to expand teaching facilities for nurses' training; (2) provide financial assistance to students of nursing, many of whom cannot afford an education beyond high school; (3) initiate new and improved programs for the support of graduate nursing education, to provide more teachers of nursing; and (4) initiate new programs and expand current programs of research which are directed toward improved utilization of nursing personnel. I shall transmit to the Congress for action legislation now being prepared on the basis of this report. II. HEALTH FACILITIES A. Aid for construction of hospitals and nursing homes The Hill-Burton program of Federal aid for the construction of health facilities has been in operation for more than 16 years. Its success can best be measured by the network of modern and efficient hospitals which have been built throughout the country, particularly in smaller towns and rural areas. But the gains have been more than quantitative. The program has had a marked effect in raising State licensing standards, and in improving the design, maintenance and operation of health facilities in every State. It has helped attract vitally needed physicians and other health specialists to rural areas. And, through development of more effective State plans, it has encouraged the first steps toward the establishment of more coordinated systems of hospital and other facilities to provide more efficient and economical health care. A year ago I asked the Secretary of Health, Education, and Welfare to review this program and to make recommendations for its future. This review has now been completed. It points out the necessity for continuing the program to meet new and changing medical facility needs. Significant progress has been made in reducing the deficit of general hospital beds throughout the country, especially in rural areas. Nevertheless, shortage areas remain and their needs should be met. Indeed, rapid population growth alone requires a constantly expanding hospital system. I recommend, therefore, that the Hill-Burton program, which is due to expire June 30, 1964, be extended for 5 years. A particularly acute problem is that of the older hospitals faced with physical deterioration and functional obsolescence. Many hospitals are growing obsolete at such an alarming rate as to hamper the quality of care. State Hill-Burton agencies have reported that there are 75,000 beds in general hospitals that have serious structural or fire hazards. Almost half of all the hospitals in the Na tion need some form of modernization. A 1960 study, based on reports made by State hospital agencies, revealed that it would cost $2.8 billion to modernize or replace antiquated general hospitals, without even adding to the number of beds. This estimate is more than thre times the present annual level of construction expenditures for all health facili ties. Because of the priority it gives to projects which increase the total number of beds, particularly in rural areas, the Hill-Burton Act as presently constituted cannot meet this vast need for modernization and replacement. In response to this critical national need, I am recommending modification of the Hill-Burton Act to authorize a new program of financial assistance for modernizing or replacing hospitals and other health facilities. Although some progress has been made in meeting the backlog of need for chronic disease hospitals and nursing homes, it is estimated that less than onethird of this need has been met and that an additional 500,000 beds for long-term patients are required to meet today's demand. The outlook for the future is even more serious. In 1960, there were nearly 18 million people aged 65 or over. By 1980, this group will exceed 24 million. As the number of older people increases and as the economic barriers to care in these facilities are eased, the demand for long-term care facilities will soar. The need for high quality nursing homes will be especially great. For these reasons, I recommend amendment of the Hill-Burton Act to increase the appropriation authorization for nursing homes from $20 million to $50 million annually. |