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a ceiling on Federal grants, and that the meeting of the minimum requirements does not necessarily entitle an applicant to a maximum grant of 66% percent. Also

For construction grants to expand the training capacity of an existing school, where no major expansion is involved, the first-year enrollment would have to be at least 5 percent greater than the highest first-year enrollment at such school for any of the 5 full school years preceding the year of application, but in any event such an increase must make possible the admission of not fewer than five additional students.

I think this presents the problem.

That is all, Mr. Chairman.

The CHAIRMAN. I might say, if I recall correctly, that with the permission of the members this proviso was included in the bill reported last year on amendment offered by the gentleman from Illinois.

Mr. SPRINGER. That is right. I just wanted to be sure that was in the bill this year.

The CHAIRMAN. I wanted to give him full credit for what the committee thought was a most appropriate amendment, and I would like to emphasize the point Mr. Springer raises:

That this committee has indicated, Mr. Secretary, that, if the purposes and objectives of this proposed legislation are met, we would expect that there would be additional places, facilities, schoolrooms, classrooms, and other things which are necessary to bring more students into the field of medicine, because, as I stated in my opening remarks a moment ago and as is pretty well known, if we are to meet the future needs, there will have to be facilities to accommodate more students in classrooms, preparing themselves for it.

Secretary CELEBREZZE. Perhaps I did not understand. I was answering the question I thought the distinguished Congressman had asked: On the level we are now, we have more applicants than available facilities. And I was trying to make the point that, on the level we are at now, we do not have the choice as to quality of students. I did qualify that later on, and I hope I made myself clear, that, if we are going to take in these new students, we have to go in two parallel lines.

One is construction for the purpose that the chairman said, for additional facilities, and the other is, through a loan program, to increase the number of qualified students who want to study medicine in this country.

The CHAIRMAN. Mr. Roberts?

Mr. ROBERTS. Thank you, Mr. Chairman.

Mr. Secretary, do you think that this problem of shortage of doctors, dentists, and other medical people is due primarily to a lack of facilities?

Secretary CELEBREZZE. I would say it is due to a lack of two things: lack of facilities and lack of the financial means of those who want to study medicine, because of the cost of studying medicine today.

The average family just cannot afford it. When you include the cost of premedical undergraduate work, then you are talking in terms of $18,000 to $20,000 in total expenditures.

So I think there are two reasons: lack of capacity and lack of sufficient numbers of well-qualified students who want to study medicine and dentistry.

Mr. ROBERTS. Is there not also the problem that a lot of students are going into other types of professions? They are going into engineering and into science professions, and would this, do you think, change that situation greatly?

Secretary CELEBREZZE. Yes.

Scholarship aid is more readily available in those areas, and fellowships are more liberal in those areas, as I stated in my opening statement. As a result, they are doing what a great many other students are doing when they do not have the financial means: they just go into some other profession.

I think that has been true in many cases.

Mr. ROBERTS. Do you think that this bill will in any way lessen the quality of the students who apply for admission to medical schools? Secretary CELEBREZZE. Oh, no. This will improve it tremendously, in my opinion.

Mr. ROBERTS. There has been quite a bit of testimony by other witnesses that one of the big troubles is that we do not have the number of students applying for admission to study medicine that we have had in the past.

Secretary CELEBREZZE. Yes.

And the point I am trying to make is that the deficiency is because of the cost of medical education.

Mr. ROBERTS. Let me ask you this: Have you read Secretary Ribicoff's statement that is contained on page 29 of the hearings last year? Secretary CELEBREZZE. I do not believe I have, Mr. Roberts.

Mr. ROBERTS. Page 29, at the top of the page. I would call to your attention the last two sentences in Secretary Ribicoff's answer to the question directed by Mr. Williams. Mr. Ribicoff, now Senator Ribicoff, said:

The bill specifically provides that in no way will there be an interference by the Federal Government in the administration or the curriculum or the running of these medical or dental schools.

Do you agree with that statement?

Secretary CELEBREZZE. Yes; such a provision is contained in your present bill, too. That is still in the bill.

Mr. ROBERTS. Going down a little bit further, he said:

As far as we are concerned, there is nothing in this bill which tells a State who they should admit and when they should admit and how they should admit. You will note that this bill specifically gives the grants to each medical school. The medical school then distributes the scholarship itself.

What I want to know is, Do you agree with that statement? Secretary CELEBREZZE. It is a fact in the wording of the bill, and, since I support the bill, I must agree with that statement.

Mr. ROBERTS. As far as you are concerned, the administration of these students, the qualifications to be passed on by the board of admissions, there will not be any attempt on your part or on the part of the Health, Education, and Welfare Department to control the admission of these students?

Secretary CELEBREZZE. No.

I think that is specifically prohibited. That is internal administration, and we are prohibited from getting into the internal administration of any institution. That is specifically stated in the bill.

Mr. ROBERTS. Thank you very much. That is all I have.

The CHAIRMAN. Mr. Schenck?

Mr. SCHENCK. Thank you, Mr. Chairman.

Mr. Secretary, I believe this bill provides for the authorization of some $75 million in matching grant funds for construction. Do you consider that a sufficient amount?

Secretary CELEBREZZE. In my judgment, it would give us an opportunity to really get started. As we continue-because we are talking now about a 10-year program-we could evaluate the program as we went along, but I think it would be an excellent start at this point. Mr. SCHENCK. Mr. Secretary, are there any laws in various States now which would prohibit the States from taking advantage of these grants, matching funds, in their own State universities?

Secretary CELEBREZZE. None that I know of, but I would have to check it further, Congressman.

Mr. SCHENCK. Mr. Secretary, do you feel that the rate of producing doctors, graduating doctors, is now keeping pace with the rate of population increase? In other words, are we maintaining the same number of doctors per 100,000 population?

Secretary CELEBREZZE. In 14 States there are fewer than 100 physicians per 100,000 population; in 4 States there are 160 or more per 100,000; but the rate for the whole United States has stayed practically static since 1940. In 1940 we had 135 physicians per 100,000 population. Today in 1962 we have 137 per 100,000, or 2 more.

If by the end of this century we are going to have some 320 million people in the United States, however, we had better start preparing

for it now.

Mr. SCHENCK. The point I was trying to make, Mr. Secretary, are the number of doctors being graduated from schools and going into practice keeping pace with the rate of the population growth? I understood you to say that they are.

Secretary CELEBREZZE. No; they are not keeping pace with the population growth. There were 135 physicians per 100,000 in 1940. That figure is 137 per 100,000 in 1962, but our projection is by 1970 it will be down to 126. So that while doctors and population have been almost on a parallel in 22 years, the population is now going up much faster.

Mr. SCHENCK. And you feel, Mr. Secretary, that the present facilities are being used to their highest and best use, so far as the number of doctors being graduated?

Secretary CELEBREZZE. I have no evidence to show to the contrary, and I think that is a correct statement.

Mr. SCHENCK. That is all, Mr. Chairman.

The CHAIRMAN. Mr. Staggers?

Mr. STAGGERS. Mr. Secretary, I think it has been established that there is a need for more doctors in America for the population, especially when taking into consideration the increase in population. Also, we need facilities, as explained by my colleague from Illinois; that different ones had asked for admission to the medical school and could not get in, and dental school; and also, by your testimony and others, that the cost of educating doctors has become prohibitive, out of the reach of the ordinary individual in this land.

I think this bill tries to fulfill all three of those weaknesses: to supply more doctors, to supply more facilities, and by helping those

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needy students with loans up to $2,000 per year. And, of course, it is not free; they have to pay it back. But we have been over these hearings, as our chairman said, and heard testimony for weeks. These are the conclusions that our committee came to in marking up the bill. Do you believe that this bill is adequate for the time being? Secretary CELEBREZZE. Yes.

Mr. STAGGERS. I know in your testimony you say that this should go ahead now.

Secretary CELEBREZZE. Yes; as I said in my opening statement. Mr. STAGGERS. I am in agreement with you, Mr. Secretary, that if we open it up and get into other fields, we might be here a long time. I want to ask one more question in relation to the supply of doctors. Are we not now using many doctors from foreign lands, that were educated in the medical schools of other nations, in emergency places all over this land?

Secretary CELEBREZZE. Yes.

I have the figures here. Last year alone we licensed some 1,700 foreign doctors.

Mr. STAGGERS. Last year?

Secretary CELEBREZZE. This is last year alone.

Mr. STAGGERS. I get this information from all over my district : that many of the doctors who have been educated in other nations are being brought in and asked to be licensed in order to take up the slack where doctors are needed.

Secretary CELEBREZZE. I can give you the exact figures.

Mr. STAGGERS. I would like to have that, if you have it.

Secretary CELEBREZZE. I will give you the figures for 1950 through

1961.

In 1950, we had 458 foreign doctors being licensed. In 1955, it jumped to 1,057. In 1956, it was 1,002. In 1958, it was 1,316. In 1959, it was 1,776. In 1960, 1,569. In 1961, 1,730.

Mr. STAGGERS. Does that mean new doctors each year?
Secretary CELEBREZZE. Yes.

Mr. STAGGERS. Or is that the total?

Secretary CELEBREZZE. There are graduates from medical schools licensed for the first time.

Mr. STAGGERS. I would like to ask this: Is that partly because of the cost, the higher cost, of educating students in this land than perhaps in other lands? Would that have anything to do with it?

Secretary CELEBREZZE. The point I am trying to impress upon the committee is that there is a shortage of facilities, plus the cost to the student, and I think you have to think of both in order to answer your question propertly.

Mr. STAGGERS. In order to supply the need which has been established for doctors?

Secretary CELEBREZZE. Yes.

Mr. STAGGERS. I am going to make this statement to you in your capacity as to a telephone call that I had this week. It was yesterday. One person interested in a hospital wanted to know if they could not come to Washington to the Army or Navy hospital here and interview the young doctors who are being discharged so that they might be able to induce them to come and work in a hospital in that area; that they had tried different places in the land.

I said, "Maybe it is a matter of not paying the proper wages." And they said they thought they were paying wages commensurate with other areas. But, evidently, they have a terrific lack of doctors. I know that in other hospitals we have had similar complaints. I wish to thank the chairman and Secretary for his testimony. The CHAIRMAN. Mr. Younger?

Mr. YOUNGER. Thank you, Mr. Chairman.

Mr. Secretary, I gather from your testimony that you consider H.R. 12 one of the priority measures of your Department; is that

true?

Secretary CELEBREZZE. Yes; and I am basing much of that upon your committee record of last year.

Mr. YOUNGER. In regard to your budget, I find only one item, aid to medical education, proposed legislation. You propose the obligation authority of only $34 million.

Secretary CELEBREZZE. We are talking about fiscal year 1964.
Mr. YOUNGER. Correct.

Secretary CELEBREZZE. Yes; because you have to get the buildings built and the student loan program set up, and you always spend much less the first year of the program than you do as you build up to capacity in the other years.

Mr. YOUNGER. That is your budget, but you are only providing for expenditures of $9 million?

Secretary CELEBREZZE. Can I give you our figures?

Mr. YOUNGER. Yes.

Secretary CELEBREZZE. On this program. We are talking about this specific program

The CHAIRMAN. For what fiscal year?

Secretary CELEBREZZE. For fiscal year 1964, for grants for construction of teaching facilities, for planning grants, for loans to medical and dental schools, and administrative costs, our total budget request would be $30,950,000.

In 1965, that would jump to $86,100,000. In 1966, that would jump to $91,300,000. In 1967, $96,500,000. In 1968, $96,900,000.

And then it would begin leveling off in the year 1969, $91,700,000. In 1970, $86,500,000. In 1971, $81,300,000. In 1972, $75,900,000. In 1973, $75,900,000.

And the total cost of this 10-year program would be $813,050,000, or about an average of $81 million a year.

Mr. YOUNGER. $81 million a year?

Secretary CELEBREZZE. That is the average. In some years more than that will be spent.

Mr. YOUNGER. But, so far as fiscal 1964, your figures of $34,352,000 for aid to medical education

Secretary CELEBREZZE. $30,950,000.

Mr. YOUNGER. $34 million, according to your budget submitted by the President. I have a copy right here.

Secretary CELEBREZZE. I will accept your figure of $34 million.

Mr. YOUNGER. Thank you.

Now, as to the amount of money and so forth, did you read your predecessor's testimony before the committee last year?

Secretary CELEBREZZE. No.

In answer to another question, I said I had not.

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