Dr. FIORDELISI. I am referring to the way he made the statement that you train paramedical personnel in the basic sciences and in the practical application of medicine side by side with the doctors. If you are using the same facilities and the same people doing the teaching and everything, why don't you Senator EAGLETON. Well, it is a different degree of exposure. Are you familiar with pediatric assistants? Dr. FIORDELISI. Yes. Senator EAGLETON. Are you familiar with the allegation, at least, that a good pediatric assistant can save the pediatrician himself up to 60 percent of his man-hour time. Dr. FIORDELISI. I am not familiar with statistics as far as timesaving and so on and so forth. Senator EAGLETON. If that be the case, and it is cited in some of the medical literature, including the "American Medical Journal," wouldn't it just be commonsense for a doctor to avail himself of such specialized paramedic talent so as to better utilize his time in the bringing of medicine to more people who are obviously in need of it? Dr. FIORDELISI. Right. That is why I said I would like to know to what extent and to what degree these personnel will be trained. That was another question. Senator EAGLETON. Well, the extent to which they are being trained, the best example now is the pediatric assistant, and the theory is that in the whole gamut of the delivery of medical services, under control of the teaching hospital, just as at this hospital they train somebody to move bedpans around or they train somebody to open the door in the morning and to lock it at night, they will also train a civilian person to render assistance in the delivery of health services up to his intellectual limit, in association with the professional. Dr. FIORDELISI. Fine. Senator EAGLETON. You also asked would any of you or your families be satisfied with the treatment given by an advanced trained medic. Don't many nurses in offices now, when you either take yourself or your children to a doctor's office, doesn't a nurse sometimes stick the thermometer in your mouth, doesn't she take your blood pressure? They can even administer an electrocardiograph. X-ray technicians take the X-ray plates, so is it unseemly that somebody who doesn't have an M.D. shingle can do something in connection with the medical profession? Dr. FIORDELISI. Right. Again I say I would like to know to what extent. Senator EAGLETON. Do you think that is the sole limit of the utilization of nonprofessional manpower? Dr. FIORDELISI. I don't know. Senator EAGLETON. Well, you have been in medical school 4 years. You are now an intern. You have had some exposure to the medical training process. Based on your judgment here for these 4 years, do you think there is an expanded role for civilian personnel to play in the medical field? Dr. FIORDELISI. I don't know. As a student and as an intern I am doing practically everything anyway. I move the bedpans. Senator EAGLETON. Doctor, what we are seeking to do is to relieve you of that onerous and odoriferous burden and having others trained to do it so that you could use your your talents to optimum advantage. Dr. FIORDELISI. I would appreciate that. Senator EAGLETON. Thank you very much Senator EAGLETON. As our next witness we have Dr. James M. Whittico, M.D., past president, National Medical Association. Is Mr. Mosley going to accompany you? Dr. WHITTICO. Mr. Mosley, would you come here, please. I appreciate your giving representatives of the National Medical Association an opportunity to testify. Senator EAGLETON. Would all of you identify yourselves for the record, please. Dr. WHITTICO. I am Dr. James M. Whittico. Mr. MOSLEY. Julian Mosley. Senator EAGLETON. Before we get that, I will list off for the record, to follow up Dr. Fiordelisi's testimony, the list of nonprofessional personnel as currently being employed by the military in Vietnam, where some degree of medical services are occasionally needed, I take it. Scope and range of paramedic specialist, and I will read them. There are 16 of them. Cast specialist; brace specialist; dental laboratory specialist; optical specialist; medical corpsman; medical specialist; clinical specialist; OR specialist; neuropsychiatric specialist; orthopedic specialist; physical therapy specialist; electroencephalographic specialist eye, ear, nose, and throat specialist; preventative medicine specialist; EGC-BMR specialist; X-ray specialist. So under the exigencies of war at least these specialists have been identified in Viet nam. Dr. Whittico, would you now please have those accompanying you identify themselves. Miss SCRUGGS. Karen Scruggs. Mr. BOND. William Bond. Dr. NICHOLS. Dr. Henry Nichols. STATEMENT OF JAMES M. WHITTICO, M.D., PAST PRESIDENT, NATIONAL MEDICAL ASSOCIATION Dr. WHITTICO. Honorable Senator and members of the Senate subcommittee, I will do my very best to keep within the time limit. I appreciate this invitation to appear before you to testify in regard to the plight and problems of education for the health professions. Your mere presence here and in other hearings such as this across the Nation gives encouragement to those of us in the health professions who have cried out over the past number of years about the abject picture of health in these 50 United States and locally here in Missouri; and to those of us who have been spiritually and mentally tortured by our inability to obtain sufficient legislative and financial help to implement plans for correction of these inadequacies, inequities, and the insufficiencies of the educational process for the health professions and their delivery of medical care to the people of our country, all of the people. I would like to take this opportunity, at the risk of losing a few seconds, to thank and to commend Senator Eagleton for his personal sensitivity, interest, and empathy for the problems in the Nation and locally that have existed in the educational system of the health professions, particularly as far as input and helping to acquire appropriations locally here at the St. Louis University School of Medicine. I feel that without such interests of people such as these that this Nation would succumb to the enemy within, that being physical, mental and moral sickness, decay, and death. As you gentlemen are well informed, even though we boast of being the richest Nation in the world, and even though we boast of being the mecca of medical education for our professional society of nations, here in the United States our infant mortality rate is worse, our maternal mortality rate is worse, our children's physical performance rate is worse, the incidence of morbidity and mortality of many diseases is worse than in some other nations of the world. The United States cannot hope to raise its average level of health without acute attention to the least of these, its minority groups, its poor, its disadvantaged black or white. Nor can this Nation hope to raise its average level of health and medical proficiency while keeping its minority groups and disadvantaged down in abject poverty, segregated and substandard housing, discriminatory and substandard educational facilities and opportunities, discriminatory and insufficient employment opportunities. We have talked long and loud over the past number of years about the need for changing the health care delivery system in this country and meeting this critical situation, but I submit, gentlemen, that as indicated by the objectives of this hearing of your subcommittee. whatever system is employed, excellent health care delivery cannot be obtained without the education of more and better health professionals. When I use the term "health professionals" I refer to the entire spectrum of medical and allied medical careers. The health of this Nation will be raised only by expert activities of these health professionals at a grassroot level in our cities and our rural areas, the suburbs and the ghettos, but, as you are well aware, there is a grave shortage at all levels of the health professionals. I also humbly submit to you gentlemen that the ideal health standards of this Nation will never be accomplished until there is a firm commitment and involvement at all levels of our society, from the President and his Cabinet to the Congress and the Senate of the United States, to the Governors and legislators of our States, the mayors and official constituency of our cities, the medical professionals in our counties, down to the individual consumer on the streets of our communities. Senator, I need not remind you or the members of the subcommittee that the health situation in these United States is critical. Nor need I, of all people, attempt to inform you that to gain populace support and sense of involvement requires intensive publicity and educational programs to awaken their awareness and sense of involvement and sense of personal responsibility if any serious objectives on a national scale are to be obtained. People as a whole are slow to become involved, but I have the greatest confidence that the people of this Nation can rise to the occasion of a critical moment. Involvement of people at levels of our society must be obtained. People must cease to think of our health professionals in the third person. This can come about only through an intensive educational program throughout the United States reaching each and every citizen. The public must be led to realize that it is through their petitions and their votes that city, State, and Federal legislation and tax revenue becomes available to insure education of health professionals and improving the health delivery service of our community. For example, in the State of Missouri no scholarship or student aid loan funds are made available by our State legislature. The people of our State should feel this individually. As president of the National Medical Association in 1968 and 1969 I made a crash and long term talent recruitment program for health professionals, with emphasis on increasing the numbers of blacks in the medical and paramedical fields as the main point of my platform. I urged that the National Medical Association constituency throw its full resources toward a crash and long range intensive contact program to get more youth, particularly black youth, into the medical field. To abbreviate this program, I might say in short, the doctors of our various societies were urged to formulate programs at their component and constituent societies whereby counselors, principals of high schools, and members of college faculties would be urged to select likely prospects and that these prospects would be tabulated and that programs would be involved whereby this composite group of prospective medical students or paramedical students then would be exposed to a program by which they would visit hospitals and other medical centers on a weekly basis with a private practitioner supporting them morally and financially and supervising their exposure education, hoping that from this students would peel off into various segments of the professional paramedical or medical fields. It would continue to be supported by the private physicians of our medical societies morally and also in helping them to obtain scholarships and seeing that they made the correct selection as to what paramedical field they would like to go into and so forth. This has seen its greatest results in Washington as a project of the National Medical Association Foundation and also now one is beginning in Los Angeles, Calif., associated with the Drew Memorial Hospital and the new post-graduate school of medicine in Los Angeles. Mr. Robinson, a school counselor, and I have met with the Superintendent of Schools of St. Louis and his staff to discuss recruitment programs in health professions and have considered the formation of a science oriented high school. This has been proposed in some other areas of the United States, and we do hope that something will come of this whereby people will be directed and will be science oriented, and thereby people will go off into the medical professional careers and possibly into medicine itself. I will not bore you, Senator Eagleton, or the members of your subcommittee with statistics on the critical manpower shortage. Senator EAGLETON. Let me say that those statistics are relevant. Your whole statement is going to be put in the record, but these statistics are relevant and I am glad to have them because we need some statistics. Dr. WHITTICO. Would you like me to refer to these? 52-314 0-71-10 Let me ask you this, doctor. We met, the staff and I met, with a president of one of the giant junior colleges in the east. That junior college has a racial mix of about 50-50, 50 black, 50 white. This president told me that with respect to paramedic type programs that that junior college was offering, he and his staff had greater difficulty in counseling black students into the paramedic field than he did whites, much greater difficulty. I said, "Well, why is that?" He said, "Well, I will just give you the frequent answer I hear the most." "I came here," says the black student, "not to be any second-rate citizen or to do a second-rate job or to take anything but the best. I am here. I want to be a full-fledged premed or a full-fledged preengineer or a full-fledged prelaw, and my aspirations are not to sell myself short, so you peddle your program to somebody else." He said that time and again he heard that from many black students, and indeed he heard it from some whites too, but in terms of the enrollment in paramedic programs, he was having desperate difficulty counseling black students into those programs because of the aspirations of the blacks in a country where they have been so long deprived, if they are to sell out that short, at least that is the rationale, they couldn't hold their heads high. Do you think this is a correct assessment and would you comment on that? Dr. WHITTICO. My comment on this, first of all, I wou'd like to state that for a number of years, to my knowledge here in the city of St. Louis and possibly elsewhere, counselors have at the level of high school actually been involved in discouraging black students from going into medicine and paramedical fields. I know this. All right. The second thing is that it is true that for a number of years the average black student does not feel that he is capable. It is so far removed from his sphere of, I would say, so far removed from his conscious desires for his lifework, that he never thinks in terms of being a doctor. He doesn't have the money. He knows he doesn't. Senator EAGLETON. Let me zero in on this. This is junior college level. These are young people in junior college. They have been enrolled in their freshman year and they meet with the guidance counselor, and he was not talking about premed. A lot of them viewed themselves as potential premeds or prelaw, preprofessional. That was the goal. Whereas, on their aptitude tests, interviews, scores, et cetera, the counselor would say, "Joe, looks to me like maybe you ought to think in terms of being an X-ray technician," or what have you, and Joe says, "No, I am straight premed. I don't want to get into anything less than that," that there was a hangup about selling one's self short, and they wanted to take a shot at the profession itself. Dr. WHITTICO. I would say that for that person who aspired to be a doctor this is probably true. We do run into this where we find many persons who aspire to go into medicine even though you realize, looking at the student, that he may not be capable, he does, in many instances, make it difficult by not wanting to go into something else. However, you take the school in radiological technology headed by Dr. Allen here in St. Louis at Homer Phillips Hospital, he has always had full enrollments as long as I remember, in his school for the past number of years, so there are students who will not aspire to go into medicine who will aspire to go into radiological technology or to any of the other paramedical fields. |