For example, a survey by the Georgia Hospital Association, reported on February 23 of this year, revealed 1,574 immediate openings in the paramedical area in hospitals and nursing homes. The shortages included a need for 20 medical record librarians, 30 dieticians, 58 medical technologists, 22 X-ray technologists and 15 physical therapists, and 6 occupational therapists. In another example, the Health Careers Council of Illinois reported in November 1965 that: "All doubts about the extent of personnel vacancies in Illinois hospitals have been removed by the just released study of budgeted hospital personnel vacancies, conducted by the Illinois Hospital Association. Total budgeted vacancies have increased 79 percent from 1,950 vacancies reported in 1963 by 284 hospitals to 3,485 reported in 1965 by only 270 hospitals." Estimates based on studies by the Public Health Service and by professional groups show that to meet our needs in some of these fields would require that before 1975 American schools graduate annually an estimated: Twice the present number of medical and X-ray technologists; Eight or ten times the number of medical record librarians, physical therapists, and occupational therapists. Mr. Chairman, an excellent appraisal of the overall situation was made by the National Commission on Technology, Automation, and Economic Progress, which only a few weeks ago published its first report. In assessing the application of new technology to meeting the Nation's health needs, this distinguished Commission said: The gap between the technological potential and our ability to apply it effectively is partly due to the lack of a significant improvement in the proportion of physicians to population. We have also not developed the proper manpower training programs for the new technologies. We have continued to hold on to our traditional and basic training programs in the various health and medical fields without analyzing the new technologies available and the real possibility of training new categories of manpower who can perform many of the functions now carried out by highly skilled and scarce professional personnel. One solution lies in restructuring our training programs with current scientific and technological developments. The only solution, in the long run, is an increase in the number of trained medical personnel, physicians, nurses, and medical technicians in all categories. For this we need an extensive planned program of Government support for the creation of more schools, expansion of enrollments, knowledge and technology can be most effectively applied, and as seems likely, training of new categories of health personnel to supplement and complement those already in existence. It will require an expansion of existing programs, and the development of new programs such as the one proposed in H.R. 13196, to meet the growing demand for health workers. We are, as you know, expanding our efforts to support the education of physicians, dentists, nurses, podiatrists, and optometrists. We are also expanding our support of programs to train subprofessional, prebaccalaureate health workers, such as practical nurses, nurses aids, dental assistants, cytotechnologists, medical assistants, and laboratory assistants. At the present time, substantial Federal aid is being made available for the support of health occupations training at the vocational and technical level. Under the Office of Education's vocational education program, preparatory training is provided for some 56,000 persons annually in the subprofessional health occupations, including practical nurses, nurses aids, dental assistants, medical assistants, and laboratory assistants. This represents an almost tenfold increase in the past 10 years. Supplemental vocational training upgraded the skills of another 18,000. Additional technical personnel are trained under MDTA and various special-purpose programs such as cancer control. One of our best training programs for the allied health professions has been in the Vocational Rehabilitation Administration. These programs have trained people in physical therapy, occupational therapy, speech and hearing, and rehabilitation counseling, among others. H.R. 13196 would permit the construction of teaching facilities which is not possible under present VRA authority. We intend that the new program, if enacted, will complement the program now carried out by VRA and will be fully coordinated with it. We believe it is important to integrate closely as far as possible, training for the allied health professions. In the implementation of this legislation the VRA and other agencies of the Department would participate fully in the planning of the program and the review and approval of applications under the program. În order to provide supervisors and teachers for subprofessional workers and to provide workers to carry out highly skilled, specialized professional tasks we must expand and improve the present training programs for allied health professionals at the baccalaureate and advanced degree levels. TRAINING FOR THE ALLIED HEALTH PROFESSIONS In 1963 the last year for which official reports from the schools are available, there were some 5,000 graduates at the baccalaureate and about 2,000 more at the advanced degree levels in medical technology, X-ray technology, physical and occupational therapy, dental hygiene and other health professions. On the basis of information obtained from professional organizations in these fields, we estimate that there has been only a slight increase in the last two academic years. Under the proposed 3-year program in H.R. 13196, training capacity for these and similar groups might be increased by 3,000 to 4,000 depending on the size of the appropriation and the speed with which the schools are able to respond to this stimulus. H.R. 13196 would authorize: 1. Grants for construction of teaching facilities; 2. Grants for schools for educational improvement; 3. Traineeships to help prepare teachers, administrators, supervisors, and other personnel in specialized practice; and 4. Project grants to develop, demonstrate, or evaluate curriculums for training new types of health technologists. The construction grants are patterned after those now available for medical, dental, and certain other health professions schools under the Health Professional Educational Assistance Act, and to nursing schools and under the Nurse Training Act. I think it is important to emphasize the qualitative aspects of this bill, especially in view of the limited number of people it deals with in relation to the total demand. We are seeking to encourage the crea tion of broad, multidisciplinary training programs and to encourage the expansion of high quality existing programs and in many colleges and hospitals. At the minimum, a project for expansion would have to result in an enrollment increase of 5 percent. By focusing on colleges and universities which now provide this kind of training for a minimum of 20 students, we are seeking to create and improve major centers for the education of this segment of health personnel. There are wide disparities between geographic regions today in their capacity to train these people, and we hope through this program to secure a more balanced distribution. The improvement grant provisions of the bill closely resemble the educational improvement grants authorized by the Health Professions Educational Assistance Amendments of 1965. Each eligible school would receive a basic grant of $5,000 times the number of allied health professions curriculums plus $500 times the number of full-time students. Special improvement grants up to $100,000 would be awarded to selected schools with three or more interrelated allied health professions curriculums to help them maintain, provide, or improve their specialized functions. Some universities with medical centers have developed comprehensive groupings of health curriculums in a college within the university, with programs that provide clinical training in the university and its affiliated hospitals. The curriculums included in these groupings may include medical technology, physical theraphy, occupational therapy, X-ray technology, or a variety of others. Thirty-eight programs now train three or more categories. Such programs now exist in a number of States: for example, at the University of Florida, the Medical College of Virginia, the State University of New York at Albany, and the University of California at Los Angeles. In coordinated programs such as these, individuals who will later work together in providing health care are trained together. Duplication in administration, faculty, and facilities are minimized. And schools based on medical centers are the logical place to provide advanced training for urgently needed supervisors, administrators, and teachers for the skilled health professions and their related subprofessional groups. Because it is necessary to expand enrollments in these centers, where they exist, the bill provides that a minimum enrollment increase of 2%1⁄2 percent (or three students) is a precondition to receiving a basic or special improvement grant. But the fact alone that this assistance is labeled as an "improvement grant" demonstrates the clear intent that these funds will in general be used to upgrade the quality of education within the training centers. The traineeships proposed in the bill would help prepare teachers, administrators, supervisors, and specialists in the various allied health professions. Like the traineeships now provided for advanced training of professional nurses, they would be administered through grants to schools, and would cover tuition and fees and a stipend and allowances for the trainees. Schools to be eligible would be required to include or be affiliated with a medical or dental school and a hospital. The traineeship would make it possible for many people now working in these allied health professional categories to return to school for limited periods to obtain the further training which is necessary to fit them for teaching or supervisory duties. In this way we will be making the fullest and most efficient use of our previously trained manpower to expand the educational base so urgently needed. The project grants proposed in H.R. 13196 are for the purpose of developing, demonstrating, or evaluating new curriculums to train new types of health technologists. One of the unknown quantities in health care is that we do not today have job descriptions for all of the kinds of people we will have to train and employ. The organization and technology of health care will continue to change. Specially trained bioengineering technologists will make possible both use and development of radically new diagnostic and therapeutic equipment. Technologists to work with physicians to extend these services will require specifically designed training. And this will require changes in the training of allied health professions personnel. The development grants proposal would allow educators sufficient flexibility and room for experimentation to anticipate these new requirements-to stay one step ahead of the game. LOAN FORGIVENESS As I Mr. Chairman, we have set our national health goals high. have said, it is our goal to provide every American with the best health care possible. In many of the poor rural areas of this country, the manpower problem goes beyond the lack of technical personnel people cannot get doctors. The President, in his January 25 message on rural poverty, recommended increased loan forgiveness for physicians who practice in poor rural areas. H.R. 13196 contains provisions which would fulfill that recommendation by extending an additional 5 percent per year of loan forgiveness to physicians who practice in such areas and making possible a total of 100 percent forgiveness for such service. I hope that this incentive will be sufficient to attract doctors to these areas. It is certainly desirable to see whether total loan forgiveness at the accelerated rate specified in this bill would provide the necessary attraction. But, as you well know, there are other factors involved which apparently outweigh purely financial concerns. STUDENT LOAN CONVERSION Finally, Mr. Chairman, H.R. 13196 contains provisions for the conversion of health professions student loans from direct Federal financing to a guaranteed and subsidized basis. H.R. 13196 would amend the current provisions for the health professions and nurses student loan programs primarily by authorizing additional means by which schools might obtain funds which would be available for students loans. Four such methods are provided in the bill which leaves intact through fiscal year 1969 the existing authority for direct Federal appropriations: 1. A school might borrow money from non-Federal sources for deposit in its student loan fund and for making loans to eligible students. The Secretary would be authorized to guarantee repayment of such borrowings (provided the interest paid to the lender is not tax-exempt income); to reimburse the school for up to 90 percent of the loss to it from defaults on student loans made from the fund; and to pay the school the amount of "interest differential"; that is, the amount by which the interest paid by the school on its borrowing needs exceeds the interest paid to the school by students. 2. A school might arrange for a nonprofit student assistance organization to make loans to students, in which case such an organization could borrow funds from non-Federal sources for this purpose and would be entitled to the same kinds of guarantees, reimbursements, and payments just described. 3. A school might arrange with one or more lending organizations for the latter to make loans to students on the same terms on which the school itself is entitled to make loans under the two programs. In such cases the Secretary would be authorized to guarantee to the lender repayment of such loans (including any portion which was canceled), and to pay to the lender an amount which will give the lender a reasonable rate of return after considering the interest the student borrower is obligated to pay. The Secretary could guarantee repayment of loans under this third method only if the school agreed to pay the Secretary 10 percent of the amount of the losses on these loans. This payment would put the school in the same position it would have been if the losses had been on loans made under the regular health professions or nurses student loan program. 4. If a school, for legal or other reasons, is unable to take adequate. advantage of one or more of the first three methods of financing its student loan needs, the Secretary would be authorized to make a capital contribution to the student loan fund of the school from a revolving fund created in the Treasury. A school would be entitled to receive such capital contributions only if it agreed to require any student who received a loan financed from this capital to authorize assignment to the Secretary of his notes for that loan and any previous loans. The revolving fund would be financed from appropriations made for this purpose in fiscal years 1967 and 1968. From repayments of Federal fund deposits received from student loan funds of schools and from the sale of beneficial interests or participation in student notes assigned to the Secretary. These provisions, Mr. Chairman, are the same as those which the President proposed this year in the higher education bill. This proposal, insofar as it applies to the NDEA loans, has already been the subject of hearings in the House before the Special Subcommittee on Education of the Committee on Education and Labor. As a result of the concern expressed by the members of that subcommittee, we have agreed that for fiscal 1967 the President will request the funds necessary to make up the difference between the funds available from private financing, and the full amount necessary, then up to the full authorization, to finance all of the student loan programs as they now exist. However, we believe the loan conversion provisions in H.R. 13196 will encourage a more flexible system of financing, and that they should be considered by this committee. It is our hope that the legislation will encourage educational institutions and student lending organizations to seek private capital-but it would not force them to do so. It would be purely permissive. To the extent that educational institutions and student lending organizations were able to secure private financing, we could reduce the amount of appropriations requested; if no private financing were secured, we would in that event seek the full amount necessary to fund the loan programs. In closing, Mr. Chairman, I wish again to express the Department's strong support for H.R. 13196 and to urge its enactment. |