The American Public Health Association, again supporting the concept of this legislation, would modify that concept in several ways-in hopes of abetting the national purpose. We know Congress is in sympathy with that national purpose, and we hope this committee and the Congress will approve these modifications: (1) There is no foreseeable limit as to the kinds and types of health workers we will eventually need. But there is a clear and obvious need, right now, for the following: Medical technologists, X-ray technologists, anesthesiology technologists, dental hygienists, rehabilitation counselors, speech pathologists and audiologists, physical therapists, occupational therapists, medical record librarians (particularly for the Nation's hospitals). Although we do not think the legislation needs redrafting for this purpose, the association feels this committee should lead the House of Representatives toward an expression of congressional intent that these workers, at least, should be covered through their training by this legislation. In addition, because the needs of even the immediate future cannot be forecast with certainty, the Department of HEW and the Public Health Service should be allowed to add to this minimal listing. (2) A second modification to the concept of this legislation, it is felt by our association, should be the provision of specific and generous sums of money to do the job. And in the subsequent years of the appropriation process, there should be no backing off from this original committment to a fast-moving, wide-spreading program. This program should be allotted, both in the original authorization and subsequent appropriations, amounts adequate to the task, remembering that it is an investment both in that dear commodity, our Nation's health, and in the career patterns open to the youth of this country. (3) A third modification would expand the legislation's concept as a career alternative to our youth. The American Public Health Association suggests addition of a program of project grants to junior colleges. But Junior colleges should be allowed to initiate and carry forward a variety of programs to attract and train health professionals and technologists of all kinds, particularly a number of talented youths who, for various personal and economic reasons, had not contemplated 4 years of education beyond high school. they must have the well-trained teachers to guard against an inferior product. Project grants to junior colleges would, we believe, both (1) enhance the legislation's major purpose of increasing the health awareness and capabilities of every community and (2) insure that at least in junior colleges, a health career opportunity is brought to the attention of, and made available to, our Nation's youth at a time when these youngsters are making the most crucial decisions of their future. The health of our Nation demands it. The youth of our junior colleges, as well of our universities and 4-year colleges, rightfully deserve it. We would like these modifications to be kept in mind during our comments on each specific provision of the proposed legislation. H.R. 13196 would provide bricks and mortar money, with up to 66% Federal funding and expansion requirements that commit participating institutions, in effect, to spend more themselves than the woefully inadequate sums they have had available in the past. This is a tried and tested pattern of Federal funding, one that has worked well to revive or create State, local, and institutional interest. Each Member of the House of Representatives should look with favor-as do the members of our association who have seen this Nation's pockets of inadequate health care on two important criteria for the Surgeon General's approval of facilities funding: (a) Each proposal is to be evaluated in the light of its effects in securing equitable geographic distribution of training facilities, and (b) Each proposal must mesh with State and local health planning, the latter hopefully to be stimulated and facilitated by another legislative proposal before this committee, H.R. 13197. A caution concerning equitable geographic distribution is in order. This provision should not under any circumstances be allowed to hold back a desirable improvement, even in areas of the richest medical background. These areas of comparative medical plenty are leadership areas, and leadership toward excellence should be encouraged, particularly when the cost can be measured in terms of relatively few dollars. This construction program must move quickly. None of these teachers, supervisors or health workers we refer to can be trained on sidewalks. Facilities and equipment must be available. Congress should so instruct the executive branch, both the Public Health Service and the Bureau of the Budget. Another major section of the bill would provide basic and special improvement grants to efforts in the training of allied health professionals. Again, this pattern was established by this Congress in last year's health professions educational assistance amendments, and it demands repetition if this Nation is to field a full health team. One notation is necessary. In considering grant applications, the Surgeon General is to take into account the relative financial need of applicants. The American Public Health Association urges that this provision not be interpreted negatively as a way of refusing grants to institutions that happen to be in areas of medical leadership. These institutions may have their riches committed to areas that will not provide allied health professionals. An accommodation of both geographic coverage and the potential for increased training is necessary. The Nation can afford basic and special improvement grants both to leaders and laggards. Both will represent an investment in the health of our citizens, and the Nation can ill afford to miss any health investment opportunity. Grants to training centers for the allied health professions would be available under the proposed H. R. 13196 as a method of attracting teachers to the field. This association considers this provision a basic underpinning for the rest of the legislation. While buildings of some form must be available, our teachers must be the best that good training programs can provide. The best teachers inspire and capture interest as well as teach. Grants for the development of new teaching and training methods, another major provision of the proposed legislation, are important, again, in assuring continuing excellence and leadership. In the view of our association, this portion of the bill is essential, just as all portions represent meaningful advances and are extremely necessary to the national mission of good health to all. Beyond the specific provisions for fulfilling the promise of the medical team in modern therapy, H.R. 13196 includes several other provisions that represent modifications or amendments to existing authorizations. Specifically, the bill would authorize additional loan cancellation to physicians who practice in rural areas characterized by low family income. This forgiveness feature we have long supported. It would add new loan reimbursement payment provisions for certain health professions and nursing students. And it would encourage the substitution of private capital for direct Federal appropriations under the health professions and nursing student loan programs. Concerning the latter, some question may arise when a borrowing student is faced with higher interest rates than now existing for the program, even though the Federal Government will make up the difference between existing interest rates and those contemplated under the private capital proposal. This may be resolved by techniques of presentation and explanation in the institutions attended by the students, but this need should be brought to the attention of administrators of the program at all levels. Despite this caution, in the interests of moving rapidly and with urgency, the American Public Health Association supports the three provisions that represent modifications to existing programs so long as adequate loan funds are available to fully meet demands. H.R. 13196 is overdue. Members of the allied health professions and technologies to be trained under this legislation will be reporting late as it is. Any further delay may further cripple the modern team approach. Those teams are necessary across the Nation to give us the best hope of success in our literal lifeand-death battle against disease and disability. STATEMENT OF ROBERT J. ATWELL, M.D., DIRECTOR, SCHOOL OF ALLIED MEDICAL SERVICES, THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE The tremendous growth in recent years of medicine and other health professions has been occasioned by our growing population, the tremendous advances achieved in the health professions, the increased demand for health services occasioned by the achievements in health care, an affluent society, and the new interest in health legislation. The demand for physicians has been tremendous and in many respects, educational facilities have not been able to keep pace with this demand. The increased use of diagnostic procedures and the introduction of very complex machines to carry out these procedures have, in many instances, completely outdistanced the busy physician. All of this, of course, has led to an increasing use of trained personnel to assist the physician. Thus, for the physician who 20 years ago would examine his own specimens, this work is now done by a trained expert in laboratory procedures. The net result of this, of course, has been that the physician's time is freed for procedures only he can perform and also the laboratory procedures are done more expertly. This experience has been multiplied many times. The awareness of a shortage of physicians and other health personnel led the Ohio State University College of Medicine to consider means whereby the health personnel requirements of the future could be met. This led to many changes in the college of medicine in the training of physicians, but over 2 years of planning has also resulted in the formation of the school of allied medical services. The wisdom in this planning has subsequently been emphasized by studies of the Manpower Commission and also by the Coggeshall report for the Association of American Medical Colleges. The aim of this school is to improve the quality and the quantity of training in the allied health professions. The needs here are great to develop teachers for other programs, to improve the methods and to develop new ones, and, just as importantly, to train these people by optimal utilization of the facilities and medical faculty so that all can function to maximum efficiency. At their meeting in April 1966, the board of trustees, the Ohio State University, established the school of allied medical services under the College of Medicine, of the Ohio State University. This school will bring together curriculums in occupational therapy, physical therapy, medical technology, medical dietetics and medical illustration, awarding bachelor degrees in all of these disciplines. In addition, under this school will be certificate programs in orthoptics, physical therapy, and nurse anesthesiology. The school will include, as of July 1, 1966, approximately 250 students in these various programs, thus representing the largest school training health related professional people. The purpose of the formation of this school is basically to train more and better members of the allied health professions. Inclusion of the various disciplines in one school allows for better coordination of effort, more efficient utilization of faculty time particularly in the medical areas. But it allows also the earlier contact of students with patients in the hospital setting and an earlier opportunity therefore to begin working toegether. We, here at Ohio State, feel very strongly that the "health team" approach to health care is extremely important and it must be achieved if the health needs of our growing population are to be met. The school also furnishes the structure to develop new programs of instruction. Such programs supply the teachers of the future. The School of Allied Medical Services must perform another very important function, however. It must also function to further education of those graduates who are now working in the various cities and towns. Thus, a program of continuing education is being developed within the school to bring new techniques and advances in all areas to various community facilities throughout the State of Ohio. This will be developed utilizing the extensive educational radio network of the Ohio State University and later, as it is developed, the television network. Continuing education after graduation is essential if we expect to achieve maximum utilization of the manpower which is already at work. The Ohio State University College of Medicine, through the School of Allied Medical Services, therefore, supports very strongly H.R. 13196 because we feel that such a program as presented by this bill will enhance the further development of schools of allied health professions in the country. In this way, the workers in the health fields will be increased in number and quality, will improve the health care of our population and will free the physician's time for optimal functioning as the leader of the health team. NEW YORK N.Y., March 29, 1966. Re Allied Health Professions Personnel Training Act of 1966. House of Representatives, Washington, D.C.: Whereas the above act is designed to aid the medical and allied medical professions by offering assistance for construction of facilities for education, for advanced education for teachers and supervisors, for curriculum revision, etc.; and whereas occupational therapy makes a noteworthy contribution to physical and mental rehabilitation; and whereas occupational therapy is not specifically named in H.R. 13196; we the undersigned urge the informed consideration of the committee toward inclusion of "occupational therapy" In the wording as well as the intent of the proposed Allied Health Professions Personnel Training Act of 1966. Such inclusion would permit continuation of recruitment, education, and research for improvement in and further development of health service through the professional contribution of occupational therapy. MARTHA SCHNEBLY, New York. BOSTON, MASS., March 30, 1966. Re H.R. 13196. Hon. HARLEY STAGGERS, House of Representatives, Rayburn Building, Washington, D.R.: Whereas this act is designed to aid the medical and allied medical professions by offering assistance for construction and facilities for education for students and loans etc.; whereas occupational therapy makes a noteworthy contribution to physical and mental rehabilitation; whereas occupational therapy is not specifically names in H.R. 13196, the undersigned urges the informed consideration of the committee toward inclusion of occupational therapy in the allied health professions in wording as well as the intent of the proposed Personnel Training Act of 1966. Such inclusions would permit continuation of recruitment education and research for improvement in and further development of health services through the professional contribution of occupational therapy. VERONIA C. DOBRANSKE, Department of Occupational Therapy, Tufts University. AMERICAN HOSPITAL ASSOCIATION, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House Office Building, Washington, D.C. DEAR CONGRESSMAN STAGGERS: This statement is sent to you to express the views of the American Hospital Association in respect to H. R. 13196, Allied Health Professions Personnel Training Act of 1966. The bill deals principally with two aspects of the training of certain health personnel. The first part proposes a new program for the training of personnel in the allied health professions. The second part deals with the refinancing of programs already existing in respect to certain health personnel. Our remarks will be directed largely to the first section of the bill. The Federal Government is, at the present time, participating in a variety of programs directed toward providing increased numbers of highly qualified physicians, dentists, podiatrists, pharmacists, osteopaths, optometrists, and nurses. There exists a large body of essential health personnel apart from the above-enumerated groups which are often referred to as "paramedical personnel." We assume it is this group to which the bill refers as "allied health professions." We shall discuss the need for specific data with respect to allied health professions personnel. We now have an overall picture indicting a large amount of unmet needs for such personnel. We know that significant amounts of health programing cannot be satisfactorily carried out unless these needs are met. We believe this legislation very wisely proposes that the Federal Government render assistance so that we may make a start in getting at the problem and avoid the loss of valuable time. At present, we lack a great amount of detailed information needed to provide guidance for long-term planning to meet the Nation's need for such personnel. It is essential that we obtain information providing a nationwide picture as to the numbers of such personnel now available, the quality of their preparation, the source of their education, the numbers of such personnel that are needed, and the financial problems confronted by such personnel in undertaking essential education. The American Hospital Association, jointly with the U.S. Public Health Service, is now undertaking a basic study which, it is hoped, will furnish much of the essential data needed. A questionnaire study is now being directed to all registered hospitals in the Nation with the purpose of inventorying categories of personnel Following are some 30 such categories: This study should develop the numbers of such personnel now employed in hospitals, the qualifications of such personnel, the estimates of the needs for such personnel now as measured in terms of budgeted vacancies, and projections as to the estimate of the numbers of such personnel that will be needed in a year's time. The information will be obtained for a base period during the month of April 1966. PART G. TRAINING IN THE ALLIED HEALTH PROFESSIONS The bill is unnecessarily vague, we feel, as to its purpose. It fails to identify the term "allied health professions." In the main, the bill appears to be directed toward assisting colleges and universities in providing construction grants for facilities and for the modernization of existing facilities and for assistance in the costs of improving the educational programs within such institutions. The bill, therefore, gives little promise of assistance in correcting the Nation's shortages of such personnel. We believe the bill is in error in failing to include junior colleges and teaching hospitals within the program of grants and assistance. Of the categories being inventories, as mentioned above, in only perhaps six is a baccalaureate degree customarily required for practice within hospitals. The vast majority of the others can be adequately prepared in not more than 2 years with, in some cases, a third year preceptorship in a qualified institution. Therefore, to provide a program of Government assistance which would be directed only toward colleges and universities offering baccalaureate degrees fails to recognize the realities of the situation. Junior colleges and teaching hospitals are the appropriate places for training most of the needed categories of personnel who do not require a bachelor's degree. Although a degree is not required for most of the categories to practice within hospitals, person who teach these disciplines do need a degree. The bill does provide assistance for this type of education as it should. We believe the bill is in error in another basic respect. It assumes that responsibilities for meeting the shortages of health personnel in the Nation will be accepted by colleges and universities. There is, as yet, little evidence that such institutions of higher learning are willing to undertake the training programs for all, or even for many, allied health groups. We question, therefore, the assumption of this legislation that the Nation's need for such personnel will be met by colleges and universities. There are large numbers of hospitals presently engaged in the training of various categories of personnel among those appearing above. We must look to these hospitals, along with all other sources, to continue the training of essential allied health personnel if the Nation's needs are to be met. Therefore, if the Federal Government intends to provide assistance which will increase substantially the numbers of personnel in the allied health professions, then consideration should be given to providing various forms of assistance to junior colleges and to teaching hospitals which are willing and able to undertake the training of such personnel. The bill provides for construction grants, for basic improvement grants, for special grants, and for traineeships for advanced training, all limited to colleges |