Senator EAGLETON. We next have Dr. Franzel, vice president, Missouri Optometric Association, accompanied by Gordon G. Heath, O.D., director, division of optometry, Indiana University, and member of the National Advisory Council on Education for the Health Professions and author of Optometric Manpower Study for Missouri. You may proceed, Doctors.

STATEMENT OF G. A. FRANZEL, O.D., VICE PRESIDENT, MISSOURI OPTOMETRIC ASSOCIATION; ACCOMPANIED BY GORDON G. HEATH, O.D., DIRECTOR, DIVISION OF OPTOMETRY, INDIANA UNIVERSITY

Dr. HEATH. I thank you for the opportunity to appear briefly before your committee, simply to draw attention to the manpower problems in one of the other health professions, namely, optometry.

In the interest of time, I have turned over to your committee a copy of the Optometric Manpower in Missouri study that I did for the Missouri Commission on Higher Education.

Senator EAGLETON. That's quite a lengthy study. That will be an appendix to the record and cited as such.

Dr. HEATH. That's fine.

If I can draw your attention to pages 20 to 22, which contains a summary of the national manpower requirements.

Senator EAGLETON. Those pages, if you desire, we'll make a part of the record in chief.

Dr. HEATH. Fine. Simply to indicate the general magnitude of the situation and the problem, let me point out that in the period from the mid-1950's until now, it would have required the production of about 500 new optometrists per year simply to replace those who were retiring, or dying, or otherwise leaving the profession. The schools of optometry, there were at that time only 10 in the United States, produced on the average 387 new graduates per year. This is to say nothing about the increased requirement, due to the population growth, and the wider spread, wider need for vision care on the part of the American public.

The studies now indicate that because of this long-standing deficit due to the underproduction of manpower, and because of the increasing needs, it would require about 1,500 new graduates per year. The schools at present are graduating about 500 per year, with the net number expected to go up within the next 2 years to about 700, but at this stage, the present optometry schools are filled to capacity. They have expanded their enrollment; they have more than doubled their enrollment since 1961.

Senator EAGLETON. Where is the nearest optometry school to St. Louis?

Dr. HEATH. In actual miles, I believe Indiana is probably the closest one. There is one in Chicago; there is one in Memphis.

Senator EAGLETON. Are these separate schools or are they affiliated in Memphis with Memphis State? In Indiana is it part of the university?

Dr. HEATH. It's part of the university there, and at Ohio State. Six of the schools of optometry in the country are university affiliated; the others are private There are, at the present time, actually 11 operat

ing schools. There is one in the medical center at Birmingham, the University of Alabama, and a new school has just been authorized in the State of New York, which will be State supported but not actually affiliated with the State university system.

The problem is simply one of inadequate facilities at the present time to possibly meet the manpower needs of 1,500 graduates per year. The total capacity for total enrollment in all of the schools now is about 3,000, when all of the classes are filled. Now, some of the schools have recently extended their curriculum, and there is a new school in Alabama which is not yet filled in all of its classes, but the total capacity will be in the neighborhood of 3,000 to 3,300, which is about half of the capacity needed for the total national production of optometric manpower. In short, I'll just summarize the whole situation, there simply aren't enough facilities, and the only answer is to create additional schools of optometry.

Senator EAGLETON. Or expand the existing ones.

Dr. HEATH. Well, those have been expanded during the existence of the Health Professions Educational Assistance Act, so since 1964, the schools have expanded and overexpanded, have increased their facilities and, as I pointed out, the enrollment has more than doubled in the schools during the past 10 years. So expansion simply doesn't seem to be a practical answer for meeting the needs, plus the fact that these States that have schools are in the position of having to be regional resources, supplying the needs of many other States around them.

In the Missouri study, for example, it's pretty clear that Missouri's needs are sufficient to warrant the creation of a school just for Missouri's purposes, and that it's unrealistic to assume that the other schools, with the needs that other States have, will assume this burden for Missouri in the proportion that is needed just for this State.

Senator EAGLETON. What is the standard optometric training program in terms of years?

Dr. HEATH. Six years, 2 years of preoptometry and 4 years of professional courses.

Senator EAGLETON. What kind of degrees then are given? Do you get a joint A.B.

Dr. HEATH. You get the A.B. or B.S. halfway through the professional program, and the O.D. degree at the end of that period.

Now, interestingly, approximately half of all of the students entering the professional program throughout the United States already have bachelor degrees or, in some cases, master's degrees. They have been in other curriculum and then have come into optometry.

Senator EAGLETON. Then how much is the training?

Dr. HEATH. Still 4 additional years; so many of our students actually wind up with 8 or 9 or more years of college work.

Now, one other thing. You'd like to know, I think, what the Federal Government's role might be in alleviating the problem.

Senator EAGLETON. What Federal assistance has been given thus far, to your knowledge, in optometric training?

Dr. HEATH. We have been included in the Health Professions Educational Assistance Act since its beginning.

Senator EAGLETON. Have there been some capital grants, has the University of Indiana gotten some, for instance?

Dr. HEATH. Yes; Indiana's new optometry building completed in 1963, was built from funds from that program and two other Federal sources, National Science Foundation and an undergraduate science facility grant. So the support has been excellent, and you can see, I think, from these figures, that there has been a tremendous impact. Senator EAGLETON. My staff tells me of all operating grants granted last year, optometry got 32 percent nationwide.

Dr. HEATH. That's on basic improvement grants and special improvement grants combined.

Senator EAGLETON. Yes.

Dr. HEATH. That's a good point, because this year the special improvement grants have been markedly reduced, and those funds which were available are being cut off. The student loan program has been cut back drastically. Indiana University, for example, applied for

Senator EAGLETON. Everybody has been cut, right?

Dr. HEATH. Yes; I'm trying to determine at the moment just how large the cuts were for everyone.

Senator EAGLETON. Student loans across the board, I read those figures earlier in today's testimony, are way down.

Dr. HEATH. Is it down to 25 percent or so?

Senator EAGLETON. The 1968 level was $26 million. President Nixon's recommendation was $12 million, and it hasn't been funded yet, you see. The House recommended $22 million.

Dr. HEATH. We just received notification recently of our award for loan funds. Indiana University has applied for $135,000 and we received $32,000, so that's a fairly drastic cut, and for the first time this year we have students dropping out because of financial problems. Now, all of this kind of thing indicates that one important aspect of the planning for increasing optometric manpower is stability and credibility in terms of the Federal assistance programs. I have a very difficult time convincing the university administration when I want to hire a faculty member as a permanent faculty member, and I suggest that the funds can come from our basic improvement grant, which the Public Health Service assures us is to be regarded as hard money. The university simply refuses to believe that any Federal funds are hard money because of the general instability of the program. I think we can plan effectively and make extremely effective use of Federal support programs that have been developed over the past 6 or 8 years, but if those are tampered with, if they are changed, if they are reduced, if the purposes are altered, then it throws a big monkey wrench in our plan.

Senator EAGLETON. I might say, Doctor, your commentary is very apt, and it's true throughout the whole gamut of education, even down to primary and secondary levels, the unpredictability of Federal funding. The big cleavage is between authorized level and actual appropriated funds, many of them being appropriated very late. Last year some of them were appropriated on December 23 for a year that began on July 1. It leaves the thing in such a quandary that school administrators at all levels, from grade school principals and superintendents on up to university presidents, graduate school deans, just can't really plan at all. It's such a chaotic mess that there is just no way to rationally plan any kind of a budget or program expansion. It's a sad com

mentary, the whole Federal program in this regard, and you are accurate in the statements you have made.

Dr. HEATH. There is one additional feature to that, too. In spite of congressional appropriations or enactment of legislation that do the job well, there is always the possibility of the program going astray because of administrative decisions lower down, and I cite, as an example of that, the administrative decision in the fourth quarter of fiscal 1970 to allocate only 5 percent of the construction funds to optometry, podiatry, pharmacy, and veterinary medicine when, in fact, 22 percent of the approved but not funded projects under the act were in that same group, so there is a deliberate shortchanging of those professions at this time.

Senator EAGLETON. Doctor, we will include in the record at this point the section entitled, "Summary of National Manpower Requirements," from the Optometric Manpower in Missouri study and the complete study will be printed at the end of this hearing day. Do you have anything you want to add, Dr. Franzel?

Dr. FRANZEL, No, thank you.

Senator EAGLETON. You have been very patient. Thank you for coming.

(The information referred to follows:)

[Excerpt from Optometric Manpower in Missouri, June 1970]

(By Gordon G. Heath, O.D., Ph. D., for the Missouri Commission on Higher Education)

SUMMARY OF NATIONAL MANPOWER REQUIREMENTS

In the foregoing sections we have considered two main aspects of the national optometric manpower situation; (1) the ratios of production and attrition, and (2) the total number of optometrists required to provide adequate vision care to the public. Although the production rate of optometrists undoubtedly reached excessive heights during the late 1940's and early 1950's which produced problems in the assimilation of so many new optometrists in such a short time, the overproduction simply compensated for a long previous period of undersupply, so that the result was that the number of optometrists in the nation rose to an adequate but probably not execessive level. The attrition rate has exceeded the production rate ever since that time, so the actual number of registered optometrists has continually declined. With a steadily growing population, the ratio of optometrists to population has become increasingly more inadequate.

Since 1954, attrition of registered optometrists has averaged 499 per year while the number of optometry school graduates has averaged only 387 per year-a net loss of 112 optometrists per year over that 15-year period. During the same period the U.S. population has increased at a rate of more than 2.65 million people per year, a rate which would require about 350 additional O.D.'s per year merely to care for the increase in population. Thus we can conclude that the graduation of new optometrists during the past 15 or so years has fallen at least 462 per year short of the minimum number needed for the nation. The average graduation of 387 optometrists per year during this 15-year period has supplied only about 45% of the number of new optometrists actually needed to maintain a minimum adequate number of registered optometrists for the growing U.S. population.

Just to compensate during the next 15 years for this deficiency of the past 15 would require a graduation rate of 1311 per year (849+462). However, the attrition rate throughout the coming 20 years or more will be increased by an average of about 170 per year as the optometrists from the post-war overproduction period reach retirement. Hence a conservative estimate of the minimum number of new graduates needed from now through 1985 or 1990 is at least 1485 per year.

As an indication of the relative conservativeness of this estimate, it can be compared to the latest estimate by Mote1 that 20,361 new optometrists would be needed by 1980 to meet the needs imposed by growth and attrition. For an 11-year period represented by his projection, this would average 1851 graduates per year.

ENROLLMENT TRENDS

The total numbers of students enrolled in all of the U.S. optometry schools since 1950 are shown in Table 4. In view of our previous discussion of the present shortage of optometrists and the inadequate average rate of production of new optometrists since the mid-1950's, the upward trend in enrollments since 1960 is encouraging. However, even though the total number of students has risen almost to the level reached in 1950-51, it still remains far short of the number need to supply the nation with adequate optometric manpower.

Sources: Health Resources Statistics 1968, U.S. Public Health Service Publication No. 1509: Optometry Student Enrollment Survey compiled by Association of Schools and Colleges of Optometry, 1969.

In 1950 the standard optometric program consisted of 3-years of professional courses after completion of a 2-year pre-optometry program. Today the professional courses in all schools of optometry require 4 years. Most of the schools changed from the 3-year to the 4-year program since 1963, so a considerable part of the upward trend in enrollment throughout the 1960's is due simply to the retention of optometry students in school for an additional year.

To produce the approximately 1481 graduates per year that we have estimated are needed as a basic minimum, would require a total enrollment of about 6300 or more students in the four-year program. The total of 2200 optometry students in 1968, even though it was the highest enrollment in the past 16 years, still was only about a third of the minimum number needed.

Because some schools have only recently changed from a 3-year to a 4-year professional program, the upper classes are not all filled to capacity, so the enrollment picture can be expected to improve rapidly in the next year or two. First-year enrollment in 1968 totalled 781 and was very near the maximum capacity of the schools at that time. Several schools are in the process of expanding their facilities and one new school is being established in 1969. But even if the average class size for all schools of optometry is increased to 90 and if all four classes in every school are filled to capacity, the total enrollment capacity in optometry for the entire U.S. will still only be approximately 4000 students less than two-thirds the number actually needed.

To meet the nation's minimum needs in the supply of optometric manpower would require an immediate increase of some 70% or more in the nation's optometric educational facilities. The inevitable delay in developing such increased facilities will only increase the present shortage and require even greater expansion to compensate for the accumulated deficit.

Senator EAGLETON. Our next witness is Mr. A. J. Henley, director, Yeatman Medical Health Center.

If you will hit a few highlights, Mr. Henley, we'd be most appreciative, and we'll print your entire statement in full.

1 Mote, Herbert G., Analysis of Optometric Needs by States to 1980, the Ohio State University, 1969 (mimeo).