Articles, publications, et cetera-Continued "Optometric Manpower in Missouri," by Gordon G. Health, O.D., Ph. D. "Organized Premedical Education," by E. Grey Dimond, M.D., F.A.C.P., La Jolla and San Diego, Calif., reprinted from Annals of Internal Medicine, June 1968 "70 Model Cities, "by James I. Threat, director, Model Cities "Summary of National Manpower Requirements," by Gordon G. "The_Hospital Conglomerate and Health Care," by Ned W. Smull, Page 573 263 389 162 266 240 "The President's Page," excerpts from selected issues of St. Louis Medicine, 1970.......... 120 Communications to: Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri, from: Joseph C. Edwards, M.D., president, St. Louis Medical Society, 108 513 Resolutions: Smull, Ned W., M.D., President, Health Resources Institute, Articles, publications, etc.: APPENDIX "A Proposal for the Establishment of a Pediatric Nurse Practitioner (P.N.P.) Training Program," by Lawrence Kahn, division of health care research, Washington University School of Medicine, St. Louis, Mo "Optometric Manpower in Missouri," by Gordon G. Heath, O.D., Ph. D., June 1970__ "Planning To Improve Medical School Trainees," by A. J. Reiches, M.D., and Richard L. Reiches, B.A., St. Louis (Clayton), Mo_-"Private Vocational Schools-Their Emerging Role in Postsecondary Education," staff paper by A. Harvey Belitsky, the W. E. Upjohn Institute for Employment Research, Kalamazoo, Mich., June 1970__ "There Is A Doctor Shortage in Missouri But-The Missouri Osteopathic Profession Is Doing Something About It," published by the Missouri Association of Osteopathic Physicians and Surgeons, E. H. Borman, executive secretary-treasurer, Jefferson City, Mo---Communications to: Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri, Borman, E. H., executive secretary-treasurer, Missouri Associa- 124 118 681 578 738 703 695 693 659 Driscoll, Glen R., chancellor, University of Missouri, St. Louis, 751 662 1970_. Kahn, Lawrence I., M.D., division of health care research, Wash- 670 Communications Continued Eagleton, Hon. Thomas F., a U.S. Senator from the State of Missouri, from-Continued Page Rabe, Charles C., president, St. Louis College of Pharmacy, St. 750 Wicks, Edwin O., M.D., Dr. P.H., Director of Health, City of Kan- 740 667 Labor and Public Welfare Committee, U.S. Senate, Washington, D.C., 701 749 Murphy, James, New Senate Office Building, Washington, D.C., from 661 Danforth, William H., M.D., vice chancellor for medical affairs, 746 Ebert, Robert H., M.D., dean, Harvard Medical School, Boston, 741 Felix, R. H., M.D., dean, School of Medicine, St. Louis Univer- 748 Howard, Robert B., M.D., dean. College of Medical Sciences, Uni- 745 Moore, Carl V., M.D., Department of Internal Medicine, Barnes 747 Nicholson, Hayden C., M.D., Director, American Medical Associa- 742 Prepared statements: American Academy of Pediatrics, Evanston, Ill___ 672 654 649 752 652 Gress, Lucille, R.N., assistant professor, University of Kansas School 663 677 HEALTH MANPOWER WEDNESDAY, SEPTEMBER 2, 1970 U.S. SENATE, SUBCOMMITTEE ON HEALTH OF THE LABOR AND PUBLIC WELFARE COMMITTEE, St. Louis, Mo. The subcommittee met, pursuant to call, at 10 a.m., in Miller Hall, Firmin Desloge Hospital, Senator Thomas F. Eagleton of Missouri (chairman) presiding. Present: Senator Eagleton of Missouri. Also present: Senator Symington and Congressman Symington. Staff members present: James J. Murphy, subcommittee counsel; Loren Walters, subcommittee research assistant; and Edward L. Filippine, staff assistant. Senator EAGLETON. Good morning, ladies and gentlemen. This meeting of the Senate Subcommittee on Health of the Senate Labor and Public Welfare Committee will now be in session. Prior to making what I hope will be a rather brief opening statement, I would like to dispose of some, shall we say, housekeeping chores. First I want to introduce and have identified, for the record, those who will be assisting me in this hearing in St. Louis this morning, as well as one in Kansas City later this week. To my right, Mr. James J. Murphy, counsel to the subcommittee; next to Mr. Murphy, Mr. Loren Walters, research assistant for the subcommittee; the other gentleman who was to my left a minute or two ago is my assistant here in St. Louis, Mr. Edward Filippine. Also let me say at this juncture-and I will repeat it at the noon hour and also at the conclusion of the hearing-that any individuals who, because of the limits of time or the inadequacy of the amount of notice given for these hearings, wish to submit a statement to be put in as part of the record may do so if they will submit such statement to us in writing within the next 2 weeks. Stated another way, the record of this hearing here in St. Louis will be held open for supplemental statements, statistics, appendixes, and the like for 2 weeks. I would now like to make an opening statement to set the background for today's hearing. Frequently we hear it said that there is a crisis in health care in this country. By definition a crisis is a turning point; things are either going to improve or they will deteriorate. In short, it is a point at which change of some type is inevitable. The course of change in health care will be greatly affected by Federal legislation in this area. Many concerned individuals have voiced suggestions for the restructuring of existing Federal medical programs, medicare, medicaid, the Health Professions Education Assistance Act, and so forth. Most recently, Senator Edward Kennedy and 14 other Senators introduced a far-reaching proposal for a national health insurance system. The Kennedy bill is one of the most sweeping, thoroughly researched programs for improving health care we have seen. It addresses itself not only to the question of financing adequate care for all of us, but also to correcting many of the inefficiencies which plague our present system for delivering health care. The Kennedy proposal will undoubtedly be hotly debated in months and years to come. Its enactment is by no means a certainty. What is certain is that our health care system will not stand still while this bill is being considered. It is equally certain that the most ingenious plan, the most elaborate mechanism, the most refined blueprint will be of little value without an adequate supply of trained health manpower to implement it. There will be no significant improvement-indeed, deterioration is the more likely prospect-if we fail to increase the numbers of health personnel in the United States. This is doubly true if any existing educational institution for the health professions should be forced to close for lack of funds. Today's hearings are designed to focus attention on the manpower problem and to obtain information relating to it. Despite some differences among the experts, there is general agreement that we need something in the neighborhood of 50,000 doctors and 9,000 dentists. It is impossible to document the need for allied health personnel since, as yet, we have not even established the possible scope of their use. How are we going to begin to meet these reeds? How much Government assistance is going to be required and, perhaps of even greater importance, what kind of assistance should that be? What is the proper role for all levels of government, local and State, as well as Federal? Will graduating more doctors, dentists, nurses, and other personnel answer the problem, or must we also examine the manner in which their services will be employed? What should we do to alter the distribution of these trained people so that not only Clayton and Webster Groves, but also the inner city and rural Missouri can receive the advantages of better health care? What is the value to the community of a medical center, with all of its related institutions, and what should be the role of the medical center in promoting improvements in the delivery of health care? How do we induce doctors to better utilize their time and talent by making use of the services of paramedical personnel to handle those procedures within the competence of subprofessionals that now consume so much of the doctor's time? Health manpower-numbers, distribution, better utilization-that is our subject for today. I repeat, this is a subject of national importance the indispensable prerequisite to any health care program, private or public. As our first witness this morning, I am pleased to call on my senior colleague in the U.S. Senate, a native of the St. Louis area and a man who has served with great distinction in the Senate for 18 years, the Honorable Stewart Symington. Senator. Senator SYMINGTON. Mr. Chairman, I have a prepared statement. May I read it? Senator EAGLETON. Yes, sir; you may. We would be pleased to have it, Senator. STATEMENT OF HON. STUART SYMINGTON, A U.S. SENATOR FROM THE STATE OF MISSOURI Senator SYMINGTON. Mr. Chairman, I am very grateful for this opportunity to present my views on the subject of education for the health professions. May I start by commending the wisdom and foresight of you, my distinguished colleague, in not only pointing up the importance of this subject but also searching earnestly for solutions to the problems contained therein. It is typical of your deep interest in people. The United States spends more than $63 billion a year on the health care industry. Nevertheless, more and more Americans question as to whether we are actually getting our money's worth. Even more critical are the problems which beset millions of our citizens who do not have any adequate medical care at all; namely the poor and various minority groups, and those of our citizens who live in isolated and rural areas. The annual national medical bill for each citizen averages out to $294 a person, more than double what it was 10 years ago. This is 6.7 percent of our gross national product which we are spending for health care, a higher percentage than that of any other country in the world. A year ago President Nixon and his principal health advisers concluded that this country faces, and I quote, a "massive crisis" in health care. The President added that "unless action is taken both administratively and legislatively to meet that crisis within the next 2 to 3 years, we will have a breakdown in our medical care system which could have consequences affecting millions of people throughout this country." The evidence strongly supports that conclusion, and the clock continues to run. It is true that the achievements of American medicine have been oustanding, to the point where it is fair to say that this is the best country in the world in which to have a serious illness. Health statistics, however, show that there is a broad gap between the best medical care this country can offer and the care actually received by a substantial portion of our population. Despite the very large amounts of money being spent on that care in this country, not nearly enough funds are being allocated to correct the shortage of medical manpower or to search for more effective ways to deliver treatment, with costs kept in bounds. Only 20 percent of the current Federal health budget of $20,600 million will be spent to provide more manpower and facilities, improve the delivery of health services, and develop new knowledge. Most of the money will go for medicaid and medicare. |