medical schools in the entire United States that are not receiving some form of State aid. Two of them are in the District of Columbia and, therefore, obviously are not getting State aid, George Washington and Georgetown. The other four are Tulane in New Orleans, Creighton in Omaha, and Washington and St. Louis Universities, so two of the six unaided private medical schools are in the State of Missouri.

No. 4, committed as it is to serve our local community first and foremost, the university wishes to make a special contribution by enhancing the number of black physicians, nurses and other health personnel to meet the needs of this specific metropolitan area. Such an objective is impossible of achievement without substantial financial assistance from resources that are not now available.

From our special assistance programs for the disadvantaged at the undergraduate collegiate level, we know from experience that to prepare a young man or woman from a disadvantaged family to qualify for admission to a medical school demands an expenditure in money and time that is substantially larger than in the average situation. Hence, it is inconceivable that any substantial number of black students can complete their undergraduate premedical education and then proceed to the costly process of medical education itself without massive assistance, either to the student himself or to the institution that is educating him.

No. 5, finally, St. Louis University is dedicated to the philosophy of integrated education for health professionals. Although other types of educational institutions can certainly make a substantial contribution, we are convinced that a medical center such as ours, with all of the resources of its schools and hospitals, can best provide an integrated program for the education and the early experience of all personnel who are involved in the medical and the paramedical professions.

Thank you very much.

Senator EAGLETON. Thank you, Father Reinert.

At this time I am sorry to announce that both Senator Symington and Congressman Symington will have to leave for other engagements. Before leaving, do you wish to make a statement, Senator?

Senator SYMINGTON. Thank you. I always avail myself of the opportunity of listening to Father Reinert because, Mr. Chairman, I never do listen to him that I don't learn something constructive.

I am late for another engagement. The chairman had said he would be kind enough to put me on as the first witness, but I became interested in Mr. Jackson and I stayed a little longer.

I want you to know, Father, that I agree with every word you said. in that statement. If the chairman doesn't put it in the Congressional Record, I would like to put it in the Congressional Record. I think the situation here is very serious and I am very proud of the fact my colleague, Senator Eagleton, is looking into this matter in this way. You can be assured that I will join him, and we, in turn, will attempt to get others to join us in solving the problem that you have presented so well this morning.

Mr. Chairman, again, my appreciation.

Senator EAGLETON. Jim?

Mr. SYMINGTON. No, thank you, Mr. Chairman.

Senator EAGLETON. My thanks to both Senator Symington and Congressman Symington.

Next we will hear from Father E. J. Drummond, the vice president for the Medical Center of St. Louis University, a member of the Naltional Advisory Allied Health Professions Council of the Department of Health, Education, and Welfare, a member of the Council on Manpower and Education of the American Hospital Association, and a member of the board of directors of the National League for Nursing.

Father Drummond?

STATEMENT OF EDWARD J. DRUMMOND, S.J., VICE PRESIDENT, ST. LOUIS UNIVERSITY MEDICAL CENTER

Father DRUMMOND. Mr. Chairman, like my colleagues, I appreciate this opportunity to speak about health manpower problems. As vice president of this institution and one who is involved in a number of national health boards and committees, I am very pleased to speak about our medical center.

There will be enrolled here this fall, to put this in something of the arithmetic of size, about 1,450 students in our center in the various health professions. Of these, about 525 will be studying to be doctors of medicine. Others will be in nursing, hospital administration, and other health-related programs.

Apart from our contribution to society in the direct delivery of health care in the ways that have been described relating to various hospitals in the community, through the direct service we offer in our own hospitals, and apart from our work in health research, this center, in terms of manpower production, is an important resource of the community, the State, and the Nation. Mere numbers show that, I think. Its strong and effective continuance, to which various important national leaders and our own university president, the chairman of our medical center and the trustees have spoken requires Government assistance.

Let me show this in some brief detail. In fiscal 1970, this center had an operational deficit of almost $1,700,000 for the year, and has incurred this kind of deficit over the past several years. Moreover, the expenditure of capital funds, exclusive of Federal money, has over the past years amounted to about $4,500,000. These operational deficits and capital spending have been funded partly from gifts but they have also been funded by using of our very limited fiscal resources. This process is a little like that of a dog chewing its tail, as this was described. "Subjectively, the dog is eating; objectively, the dog is being eaten."

The center has, of course, been aided by Federal funds. Most recently there were the matching funds of almost $9.8 million that were awarded for capital construction.

I, too, want to add my appreciation and that of all of us to you, Mr. Chairman, and to the other Senators and Congressmen who have done so much to help obtain this grant. We are very conscious of it. For operations, besides the Federal funding for capital affairs, we have received training and research grants in various health programs, as well as some student aid in scholarships and loans. We receive no State subvention, as Father Reinert, our president, has indicated. We are, however, endeavoring, along with Washington University and the two colleges of osteopathy in the State, to try to work out

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some kind of contractual obligations with the State for educating physicians in Missouri. Our State falls below the national average so far as its supply of physicians is concerned.

Essentially, then, all of our governmental assistance has been Federal assistance and, without it, this center and most other centers connected with private universities would have disappeared.

I wish here to speak briefly to what I see as a rationale for Federal health support, and then to propose an effective instrument for providing it to institutions that prepare health manpower.

The rationale: The Federal Government, either as cause or catalyst, should take strong and effective measures to see that all of its citizens have the opportunity, as well as the capability, to receive health care. The Federal Government should see that no regulations or lack of funds or other means necessary at community or State levels be allowed to prevent this. I see this as basic, for people move about. They are not confined to a particular community or a particular area. They are mobile. Some States and some communities and cities lack full fiscal resources. But people, whoever and wherever, are citizens and human persons. The rock-down reason why any social institution or program is important is because it answers to real needs of real persons. Persons have an essential importance that measures and explains every social instrument and organization that has significance. If these systems or organizations are not for persons, then, to illustrate from the health care field, professional work becomes meaningless. Research is a sophisticated form of solving jigsaw puzzles, and teaching and service, however we qualify them, are merely some kind of Linus security blanket.

The role of the Federal Government may, then, require the supplementing and reinforcing of local and State resources in the matter of health at the service as well as at the educational level. In all of this, the Federal Government must insist on the common denominator of concern for the human person.

To speak to medical centers and their stability, to insure these, I would urge that governmental support take the form of institutional grants along these lines. To be eligible for such grants, a health professional school or a medical center that trains a variety of people in different professions related to health care and health delivery, would be required to develop, let us say, a 5-year plan, subject to annual review and revision. This plan would include the totality of their effort. Such a plan would include proposals about objectives in terms of enrollment, educational programs, and projected operational, as well as capital, expenditures required to achieve the outlined goals. The plan would also include various sources of income expected from gifts, foundations, tuition, as well as from any community or State support.

My proposal is, then, that the difference between total income and total expenditures be made up by a Federal institutional grant on the basis of an approved institutional plan.

Without going into elaborate detail, here are some of the things that that could accomplish. Such a grant would do away with the present awkward, fragmented, and expensive funding mechanisms. More than that, such grants would permit and still allow institutional flexibility, appropriate institutional autonomy, and close relationships with various publics served, either local or State. This proposal could provide

an effective mechanism for the Federal Government to provide stability to the institutions and centers which furnish the needed health manpower. It could give the Government a much more direct voice in representing the general public and helping by way of incentives and support to develop the kind and the amount of health manpower this country needs and requires.

Finally, it would enable this center and others like it-and there are a number like it-to get about their real business, not of mere survival, but of producing the manpower really concerned for every man's health.

Mr. Chairman, thank you for this opportunity to appear before your committee. If there are questions that you have, I or members of the panel will be glad to answer them.

Senator EAGLETON. Thank you, Father Drummond.

Our final witness from the St. Louis University group is Dr. Robert Felix, the dean of the St. Louis University School of Medicine. Dr. Felix.

STATEMENT OF ROBERT H. FELIX, M.D., M.P.H., DEAN, ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE

Dr. FELIX. Mr. Chairman, members of the staff, gentlemen, I am pleased to have the opportunity to appear before you. As a matter of fact, as I have been sitting here listening to my colleagues talk and to those who preceded them, I have had a strange feeling of nostalgia steal over me when I think of the 20-odd years that I testified before this committee when I was in Washington with the National Institutes of Health.

Senator EAGLETON. Doctor, did you give the same testimony and we gave you the same inattention? Has this been a 20-year standfast footrace?

Dr. FELIX. No Senator. I always figured that if I could say something sufficiently upsetting, challenging, irritating, they would quit talking and listen to me.

Senator EAGLETON. Irritate me, Doctor.

Dr. FELIX. If I couldn't, it was all in my prepared statement anyway, so I didn't lose anything.

I remember, though, those wonderful days many years ago when the then chairman of this committee in the Senate, my dear friend, Lister Hill from Alabama, and his opposite number in the House, the late Congressman John Fogarty, were concerned with how to do just what we are talking about now. We were able to work with the House, with the Senate, with the administration to develop much better and stronger programs for the people of this country. I felt a little homesick, as I say, as I heard my predecessors speak.

I am on record in a number of places and a number of times about the situation with regard to medical education generally, and St. Louis University specifically. I suspect that I even make some of my colleagues and some of the alumni a little nervous at some of the things I say. But as the umpire said, I can only call them as I see them, and I think no harm can come from speaking the facts as they are.

Our challenge and our problem here at this school, as in many other schools, is how to save time, how to teach all that we must teach, and

how to increase the output of physicians, without in any way compromising the quality of medical education.

This would be fine if we were able to finance an adequate curriculum, adequately staffed. But every time we get a grant of an institutional nature to help us move forward a bit, we are told we must take more students, which means that we are back to where we were, if not behind that point, with regard to the number of faculty for the number of students.

I think there are ways that this can be met, and I would like, with your permission, Mr. Chairman, to address myself to one aspect of this problem and try to suggest a possible solution. There are others, I know, but the time is limited, and I would like to take just a few minutes to do this.

I am sure that what I am going to say will not be agreed to by many of my colleagues, many of whom are more competent and more distinguished than I by far, but out of disagreement comes dialog, out of dialog comes exchange of information, out of exchange of information can come plan and design, and maybe out of this somewhere, somehow, we will be able to attack this problem, at least on an experimental basis. I would be less than candid if I didn't tell you that I would like to be at the place where such an attack will be carried forward. I have been fighting the establishment as far as the way things have always been in health care and other similar situations for 30 years and I am too young to stop now.

The student's introduction to medicine traditionally has been via the basic biological sciences in which he has been required to be reasonably proficient before he moved on to the diagnosis and treatment of patients. One cannot properly evaluate suspected disorders of the body or mind nor institute effective steps to prevent illness unless he has a good knowledge of those phenomena which allow us to live and breathe and think and defend ourselves against nature's onslaughts. This knowledge, in my day, was imparted to the medical student early in his career, and such subjects were often taught for their own sake alone and without too much regard to their application in the living, breathing patient. As time has gone on, we have modified this a great deal and have brought more of the clinical subjects into the basic science years. This has been, I think, a very constructive step forward. More students are interested in clinical medicine now than was true even 10 years ago when the greatest glamour was attached to research.

In our school, for instance, I have recently appointed a committee of the faculty to examine critically and in depth the role of the basic sciences in medicine. I have asked this committee to examine both the content of the courses and their methods of presentation. What we are really looking for is time which can be saved and can be directed to some of the more recent innovations in medicine, such as patterns of health care, how you deliver health care to patients, how can you improve proficiency, and so on.

I appointed this committee because one possible way, and the one on which I would like to spend some time in talking to you, would be to shorten the amount of time the students spend in medical school studying the basic sciences: anatomy, physiology, biochemistry, microbiology, and so forth.