MORE THAN WERE ADMITTED LAST YEAR. IF THESE STUDENTS ARE TO
RECEIVE WHAT THEY ARE CAPABLE OF ABSORBING AND WHICH THEY SHOULD
RECEIVE TO PRACTICE MEDICINE IN THE LAST QUARTER OF THE TWENTIETH
CENTURY TO SAY NOTHING OF THE EARLY YEARS OF THE TWENTY-FIRST
CENTURY, IT MUST BE DONE BY WHAT I CHOOSE TO CALL THE MEDIUM
OF THE EPISTLE AND THE APOSTLE. THEY MUST LEARN FROM TEXTBOOKS
AND CURRENT LITERATURE AND FROM LECTURES, BUT THEY MUST ALSO
LEARN BY SEEING THE PROCEDURES DONE BY HIGHLY QUALIFIED PEOPLE
AND THEN REPEATING THEM THEMSELVES UNDER SUPERVISION. THIS
MEANS RELATIVELY SMALL GROUPS OF STUDENTS WORKING WITH AN INSTRUC-
TOR. IF WE COULD ACCOMPLISH THIS OBJECTIVE WE WOULD BE IN AN EX-
CELLENT POSITION TO PREPARE STUDENTS WHOSE INTEREST WAS IN THE
AREA OF FAMILY PRACTICE AND COMMUNITY MEDICINE. BY THE SAME TOKEN,
WE COULD HAVE THE OPPORTUNITY TO EXPERIMENT WITH OUR CURRICULUM
AND TO EVALUATE THE CHANGES AS THEY WERE MADE, WE WOULD CERTAINLY
BE ABLE TO FIND MORE DEFINITIVE ANSWERS TO QUESTIONS THAT ARE
BEING ASKED NOW IN SO MANY QUARTERS CONCERNING INCREASED PRODUC-
TION OF PHYSICIANS AND SHORTENED CURRICULUM. WE COULD DO ALL
THESE THINGS, GENTLEMEN. WE HAVE THE MOTIVATION, WE HAVE THE
KNOW-HOW. NOW, THANKS TO THE CONGRESS AND THE DEPARTMENT OF
HEALTH, EDUCATION AND WELFARE, WE WILL HAVE MORE AND BETTER
FACILITIES.

As I SAY, WE COULD DO THESE THINGS IF WE HAD THE FUNDS TO CARRY THEM OUT. WE HAVE MADE NO SECRET OF OUR CRITICAL FINANCIAL SITUATION. IF WE CAN HOLD THE LINE AND CONTINUE WHAT WE

ARE NOW DOING, WE WILL THANK KIND PROVIDENCE. BUT HOW WE WOULD LIKE TO UTILIZE OUR POTENTIAL AND MOVE FORWARD TO MEET THE NEEDS OF TOMORROW!

I HOPE MR. CHAIRMAN AND GENTLEMEN, THAT WHAT I HAVE

SAID HERE IN THE FEW MINUTES ALLOTTED TO ME HAS GIVEN YOU SOME
VIEW INTO OUR PROBLEMS, OUR HOPES, OUR DREAMS HERE AT SAINT
LOUIS UNIVERSITY SCHOOL OF MEDICINE. I HOPE I HAVE ALSO BEEN

ABLE TO COMMUNICATE TO YOU MY FIRM CONVICTION THAT THESE DREAMS
CAN IN MANY INSTANCES BE REALITIES IF WE ARE GIVEN THE OPPORTUNITY
TO PUT THEM INTO ACTION.

I WILL BE HAPPY TO ATTEMPT TO ANSWER ANY QUESTIONS YOU

WISH TO PUT TO ME.

THANK YOU VERY MUCH.

Senator EAGLETON. I have some specific questions that I will address to particular members and then a couple of questions that I will throw up for grabs and whoever has the handle on it can grab it.

Starting with you, Dr. Felix, I have a question regarding the experience of Johns Hopkins which is one of the premier medical schools in the country, and which, I should add, is in desperate financial straits and this came as a total shock to me, that Johns Hopkins would be on the brink of financial disaster, but they are, and it is questionable whether they can continue in existence. They have attracted a goodly number of minority students to Johns Hopkins but, in graduating those minority students, they found that the graduate went to suburban. Baltimore, Baltimore County. They went to suburbia, the overwhelming bulk of the black medical graduates, and thus the areas of greatest medical need, the inner city of Baltimore, which is somewhat similar to the inner city of St. Louis, was still left bereft of adequate medical manpower.

So I ask you, if those facts are accurate, and I believe they are, how are we going to go about the business-"we" either being Government or preferably private medicine with soft but certain governmental inducements of inducing either black graduates or white graduates or brown graduates to locate and to practice and to service the inner city area?

Dr. FELIX. I am familiar with the situation in Baltimore, Senator. I had my graduate training in public health at Johns Hopkins, and I am aware of that part of the city, because the eastern health district of Baltimore was our classroom, really, for much of our work, and it is very similar to our area here in St. Louis.

It is a complicated problem and I think that there are several different facets to it. This is why it is so complicated. You cannot look at one face and think you see the whole object.

No. 1, unless clinical experience, professional experience is given, not just offered, but given to students in this setting, they will have no knowledge or no interest. The great majority of medical students come to medical school because they are really motivated through that greatest of human instinct, compassion. They want to cure the sick, they want to help the suffering. They would like to stave off death. This is truly so. What happens along the way, we have all heard stories about this, but, nonetheless, this is what they come for.

If, while they are still in their early formative years, in their freshman year, they could be assigned to some health care activity as part of their formal curriculum in these areas of the city and, if this could be followed up with more and more challenging work as they go along in these areas of the city, not exclusively here, but here as part of their total experience, a number, I would not know until we have tried it what percentage, but I think a significant number would elect this, at least for a time, as all or part of their practice area. That is one face. Another face to this is, however, and I am sure you are as aware of this as I am, a part of the picture we don't talk about. When I was a young medical student in Denver, there was no part of the city I couldn't walk into safely if I had my black bag and my white suit on and a stethoscope in my pocket, which made me really official. I could walk up to any person in any dark alley and say, "How do I get to X Street?" and he'd say, "I will show you, Doc." You can't do that now.

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The young medical student, the young intern, the young doctor is really very uneasy, and justifiably so, when he is in that area.

I know of one medical facility, private medical facility in an area of the city, which is moving out because their patients won't come any more after dark.

Senator EAGLETON. Isn't it true that Grand Avenue, which used to be the capital of medicine, so to speak, in St. Louis, is almost now totally bereft of practicing physicians?

Dr. FELIX. There are still a number in the Missouri Theater Building, I believe, and the University Club Building across the street. Senator EAGLETON. But diminishing numbers?

Dr. FELIX. Diminishing numbers, and their practice is more and more confined to daytime practice. It used to be that the doctor would have evening hours.

I am aware, Senator, that our city is in tough financial straits. I know that we are having trouble finding the funds for adequate police and fire protection, but just as a scientist facing a problem and trying to find out its answer, I must say that whether we can afford it or not, until we can provide security for people, the physicians and those others who come in there to give professional services, we are going to have a difficult time delivering medical service in that area.

This is further complicated by the fact that many of these people do not like to travel outside of the area. In other words, the solution, as I see it, is more clinical experience in the area and more security provided in the area for all the citizens.

Have I answered your question sufficiently?

Senator EAGLETON. Yes; I think in part, Doctor. I am going to pursue it with you a bit more.

Assuming what you say to be accurate, that any individual, be he professional or nonprofessional, wishes to work in environs that are comfortable and safe, nevertheless, I take it you will acknowledge the fact that this medical crisis we face is not only a matter of numbers-those are important-but it is also an acute problem in distribution. Isn't the distribution factor a severe one?

Dr. FELIX. That's right.

Senator EAGLETON. Would you say this, that most black doctors, like most white doctors, will go and service areas where the paying patients are? Wouldn't that be the case?

Dr. FELIX. I have no objection to our present system, believe me, but I am just making a statement of fact as I see it. As long as we have a system in which the physician is working essentially as an entrepreneur; that is, he sells his services and is paid for his services by the recipient of those services or by a third party, of course a person is going to go where he can be compensated adequately because if he doesn't, he is going to go hungry. He has his office to pay for, school debts to pay for. You see, we meet ourselves coming back. The Government says we are going to move toward loans to students, not scholarships, and these loans are at rather stiff interest, so the poor fellow has to at least break even. By the time he has done that, he has been practicing in the more affluent community for a few years and he likes it. Senator EAGLETON. Does that mean then that we will make no inroads on altering the distribution pattern if the graduates, whatever be their color, go to where the money is because they must be compensated

in order to provide for their families? That will mean, then, that doctors will not gravitate toward the poor unless we in some way alter the method and structure of payment?

Dr. FELIX. I believe if I had to answer you yes or no I would have to say yes, you are correct. I believe, by the same token, that these same doctors, if there would be some way they could break even, so far as that time spent in that area is concerned, many of them would do it. However this may be, if, for instance, there were attached as a provision to a loan system, that their loan could be forgiven if they spent a year per so many thousands of dollars indebtedness in this area, a significant number would spend some time in the underprivileged area, and out of this number some would like it and stay.

I come from a small town in Kansas. When I was a young fellow many of the medical students would go out into the community, there were good, well-to-do farmers out there, and the young physician was going to stay there long enough to pay off his debts and then go to the city to practice. It was amazing how many of these doctors in that day stayed there because they liked it, they liked the people.

There are many things about many areas of this city or any other city you want to name, which would be attractive if a person could fed himself and raise his family safely.

Senator EAGLETON. You heard my statistics when I threw it in the record somewhere earlier that only seven students nationwide have availed themselves of the loan forgiveness program which was designed to induce them to go into the poverty or medically undersupplied

areas.

Dr. FELIX. I don't know why, and I ask my friend beside me. Father DRUMMOND. I have this comment. What it is worth from a celibate man, I don't know. I have talked to some doctors about it and the problem is not merely the doctor himself as an isolated individual but as part of a whole family social system. So besides the matter of the incentive in getting a physician to understand what the needs of the community are by actually working within the community, as Dr. Felix described, and besides the matter of the fiscal incentive directly imposed upon the physician, there is the whole matter of what it means to live in a social milieu which befits or, let's say, adjusts, accommodates his family and his concern for them. I am not by this siding pro or con on the lib movement or anything else, but I am pointing out that there is one additional factor and I think we have to, both in and out of schools, and schools alone can't do this, emphasize that there is an incentive that comes from within, besides the fiscal factor and the rest there is some kind of concern for persons that has to be more broadly developed in this country and I think this has to show itself in the kind of mores and standards that people have by a series of matters that influence a person's health. Just as they say environment influences a person's health in restorative health, so are social mores things that color and clarify this.

Senator EAGLETON. This question is for either Father Drummond or Dr. Felix. Congressman Symington in his statement mentioned the Medex program that is in operation at the University of Washington Medical School out on the west coast. This program, amongst other things, tries to attract into it medical corpsmen, veterans, who