training in the numerous community hospitals while affiliated with colleges and not administratively a part of the college. This bill can work with this understanding. In my original thoughts about this bill I reflected this in reference to grants being made directly to the community hospitals because in the past community hospitals have not had the support necessary to obtain adequate space, microscopes, and other equipment necessary for training. We have not had the funds to pay stipends to students for their living costs which may amount to $100 per month. And we have not had the funds to obtain teaching supervisors where these might be available. So this is where I think we need some help in the community hospitals in order to do these things. Now it can become very confusing as to the portion of a grant which is given to the college, as to how much of this might then go to the community hospital. It may be that the community hospital receives only two or three students in that particular affiliated college. Well, this means a very small sum. This would be insignificant probably in an overall program. So, if the bill is modified then I would think that consideration should even be given to grants directly to the community hospital programs which have a sufficient number of students to make them what we consider a better school. And we do have figures to show that schools which have a certain number of students perform better on the examinations, their enrollment is greater and they have fewer failures on the registry examinations, and now there is another small point that I just learned about in recent days and that is that the Veterans' Administration hospitals are being or will be supplied with funds to augment their training programs. I have not seen this bill but I believe it is one that was presented by Mr. Teague. In this bill they planned to establish additional numbers of schools. Out of this the technology students will receive a stipend of $152 per month and this is above and beyond what we have been able at this time to supply students in our training program. This then means that we will be again in a competitive situation with the Veterans' Administration hospitals so far as stipends to students are concerned. In Atlanta where we are constructing and completing a very large Veterans' Administration hospital the students would more likely lean toward going to a school where the stipend is greater. In other words, in comparing a stipend which I have to offer at the present time of $80, per month, it is likely that the student would prefer the $152 per month. Mr. MACKAY. I would like to again state that if you will consider what language might be explicit without being too rigid, I would like to see this offered by way of amendment. Dr. GODWIN. Are you suggesting modification in reference to the Mr. MACKAY. The community hospital, with regard to the matters you mentioned in your statement. Thank you, Mr. Chairman. The CHAIRMAN. Thank you, gentlemen. Mr. Kinsinger, Director of the Community College Health Careers Project of the University of the State of New York, representing the American Association of Junior Colleges. Have a seat, sir, you may insert your statement in the record and summarize it or you may read it, as you wish. STATEMENT OF ROBERT E. KINSINGER, DIRECTOR OF THE COMMUNITY COLLEGE HEALTH CAREERS PROJECT OF THE UNIVERSITY OF THE STATE OF NEW YORK, STATE EDUCATION DEPARTMENT, ALBANY, N.Y., ON BEHALF OF THE AMERICAN ASSOCIATION OF JUNIOR COLLEGES Mr. KINSINGER. Thank you, Mr. Chairman and members of the committee. My name is Robert E. Kinsinger, and I am currently serving as director of the Community College health careers project of the University of the State of New York, State Education Department, Albany, N.Y. I am here on behalf of the American Association of Junior Colleges. The burden of this statement is that legislation, such as H.R. 13196, intended to assist in alleviating shortages of personnel in the allied health professions, should also recognize the need and provide for support of education and training for health service technicians. The Allied Health Professions Personnel Training Act of 1966 is clearly based on recognition of the fact that the traditional health team of doctor, dentist, and nurse can no longer serve, without assistance, the health needs of patients. Therefore, there is no need to labor the point. However, to bring the picture dramatically up to date in terms of the magnitude of change in the composition of the modern health team, a quotation from the recent Coggeshall report, "Planning for Medical Progress Through Education," is appropriate: Once it took only one doctor to resign himself and the child's parents to the inevitable death of a blue baby. It now takes a team of medical specialists and auxiliary personnel to correct the congenital abnormality of a baby's heart to insure the child a normal life span. At least 15 persons, including 4 surgeons, are needed in the operating room for the repair of a congenital lesion of the heart. More than 100 medical specialists, nurses, and skilled technicians are involved in preparations for, and performance of, the operation and in the postsurgical care of the patient. The reference in this quotation to skilled technicians is of particular significance. It takes many more skilled hands to apply modern medical knowledge. The physician increasingly must analyze, plan, and administer services which are provided by others others to whom he delegates in large measure routines carried out under his direction. Originally "others" referred to the nurse who was responsible for all paramedical services to the patient. The total environment, after the departure of the physician, was her province. What has happened to her original responsibilities in the intervening years? Perhaps a short list of original nursing functions, indicating how these activities are currently shared or completely transferred to other workers, might serve to remind us of shifting health service responsibilities and the consequent changes in educational requirements for both professional and technical workers. Original RN functions and activities Diet therapy Allied health worker now providing the service Dietician. Social Service: Related to disability, hard- Medical social worker. Medical records: Maintenance of charts, Operating room. Nursing specialities: Recovery room, postoperative nursing care, monitoring devices, hypothermia, pacemakers, Xray, oxygen tents, cannula, etc. Employment interviews (for nursing service). Administration (nursing unit)_. Registered medical record librarian and medical records technician. Recreation therapist. Physical therapist, occupational therapist, and occupational therapy technician. Scrub nurse. Circulating nurse, etc. Inhalation therapy technician, bio- Personnel director. Ward manager. If other existing allied health professions, both professional and technical, are added to this list as well as those still emerging or anticipated, a vast and complex educational job is indicated. Some of the most enlightened planners are undertaking a careful analysis of the skills and knowledge currently being demanded of a worker to function safely and effectively in each allied health profession. Constant review will be necessary because functions are wed to the art and science of medicine and these are continually changing. Not only must individual curriculums change as medical practice changes, but planners must be alert to demands for new categories of personnel. To help relate specific levels of preparation and service to the broad spectrum of health service personnel-professionals, technicians, and practical aids-the following chart has been prepared. *Generally require two years of post-secondary education Mr. KINSINGER. I would like to show you this chart to indicate the level of which I am speaking. Some of you can see it. If you can't, this chart appears in my formal statement. The bill as it presently is constituted is concerned with the area here, paramedical and paradental. We run from one end of the continuum in the health field, from down here where we have ordinarily aids and so forth who are primarily involved in motor skills and very little with background. In other words, it is the how to do something, not so much of the why of doing it. As you move up the scale you get less of the motor skills, the how, and more of the background, the physical and biological science base. At this level, the technical assistance level, the junior colleges are primarily concerned. Here theory and skill are broken down about half and half. The level with which this bill is concerned is the paramedical level. There are some problems with a chart of this sort. One of them that I run across most frequently is someone looking at this chart and seeing how little skill is indicated up here at the physi cian and dentist level and they are concerned that their surgeon has only this much skill with his hands. So you can see the problems inherent in this kind of a chart. A trend toward recognition of the responsibility of professional practitioners to utilize more effectively the skills and knowledge of technical personnel has been spearheaded by the dental profession. With financial help from the Federal Government, dental schools have instituted programs specifically designed to teach graduates how they can serve public health needs better through a careful sharing of appropriate functions with dental auxiliary personnel. The Surgeon General recently highlighted this important aspect of health service. At the 1965 White House Conference on Health he stated, "Year by year, our top professional personnel are being trained to perform still more complex tasks. How long can each profession afford to hang onto its simpler functions-the routine filling of a tooth, for example, or the several easily automated steps in a medical examination? How can we train the physician or dentist to make full use of the skills available in other people, freeing himself to perform only those duties for which he is uniquely qualified?" There is an increasing movement toward interagency and multidiscipline planning for education and training in the health field. The recent Joint Conference on Job Development and Training for Workers in Health Services sponsored by the Department of Labor and the Department of Health, Education, and Welfare is a case in point. A division of the U.S. Office of Education has had a standing Advisory Committee on Health Occupations Training for many years. The work of the National Commission on Community Health Services generated 70 recommendations regarding health manpower. Also extremely promising are two newly formed interorganization committees on health technology education: one between the American Association of Junior Colleges (AAJC) and the National Health Council on Medical Technology Education. The AAJC and the National League for Nursing have had a similar interorganization commlttee for many years. Writing on "The Increasing Role of Paramedical Personnel" in the September 1965 issue of the Journal of Medical Education, Dr. Robin Buerki states "It would seem that junior colleges across the country offer the most appropriate and the most immediate solution to the problem of training in specialty areas where shortages exist. Technical education in many paramedical specialties could easily be accomplished in a 2-year curriculum which would also provide an opportunity for *** llberal arts subjects." In the light of this statement it is important to note that the first task the AAJC-NHC committee has set or itself is that of writing guidelines for the development of sound educational programs for health technicians at the junior college level. The knowledge explosion has overwhelmed the professional and escalated his responsibilities. A large bulk of the services carried on under professional direction must be rendered by technicians and assistants. The list of supporting technicians is long and some of the names such as medical laboratory assistants, X-ray technicians, opticians, inhalation therapy technicians, and dental assistants are well known. Others, many others, are doing work, but their role as medical and dental assistants is less well developed. They not only assist the physician and the dentist, but, in this expanding field of |