Page images
PDF
EPUB

The problem was clearly outlined by Dr. James A. Shannon, former Director of the National Institutes of Health and now professor and special assistant to the president of Rockefeller University. In a recent analysis made for the Subcommittee on Executive Reorganization and Government Research of the Senate Committee on Government Operations, Dr. Shannon stated in part:

The critically important shortage of almost all types of health personnel is generally acknowledged. The program proposals contained in the 1971 budget will neither remedy these shortages nor provide for a more equitable distribution of health personnel in the middle range (5 to 10 years) future.

Yet it is generally agreed that until the manpower shortages are remedied— Dr. Shannon continued

it will be difficult to contain rising health costs and, at the same time, provide for the delivery of more effective health services ***

If appropriate actions are not taken at this time and programs are not modified accordingly

He concluded—

even further deterioration of the health care system will most surely and rapidly ensue.

Mr. Chairman, at a time when there is an urgent need to expand our health manpower, we find that many of the medical schools in this country are already in serious financial straits. This is particularly true here in Missouri in the case of the St. Louis University School of Medicine.

Dr. John Cooper, president of the Association of American Medical Colleges, told the Senate recently that the perilous financial structure of our medical schools has reached such a degree of instability that the whole structure was gravely threatened, particularly in the case of private schools. The latter constitute about half of all the medical schools in this country.

So we see that at least one important part of the grave problem, Mr. Chairman, is being considered by you today, and is readily susceptible to analysis. The Government simply does not provide adequate funds to meet health manpower needs; and, judging by this administration's proposed budget, it does not intend to do so.

A Federal grant was announced recently to help construct the proposed University of Missouri-Kansas City School of Medicine. This grant was aimed at correcting Missouri's deficit of 100 new doctors a year. No grant has been forthcoming to help build the teaching hospital, which would be vitally important to the effectiveness of any new school; and the medical school grant came out of a national backlog of more than $300 million in fund requests for new medical schools which have been recommended, but for which money has not been made available.

More money is not only needed to pay for new teaching facilities; it is needed also to restore the financial health of existing facilities. Federal research grants make up a significant portion of the income of medical schools, and the low level of Federal grants in the past year, as well as in the proposed budget, combined with rising costs, has been a severe blow to many of these schools.

More money for student support is also needed if medicine is not to become a profession that only the rich can afford to enter. Middleincome students are now having increasing trouble financing their education, and qualified low-income students need more support if we

are to achieve any significantly greater representation of the various minority groups in the health professions.

It is clear, therefore, that far greater financial support will be required if we are to make any progress in meeting the current shortage of medical personnel. That shortage is now estimated at nearly 50,000 physicians and several hundred thousand nurses and technicians. The other parts of this problem are less susceptible to quick analysis. As an example, it requires up to 10 years to train a doctor and, even if we increase enrollments now, we are faced with a continuing shortage through most of the coming decade.

This poses another question: How do we best cope with such a shortage? Perhaps one logical answer is to adopt more innovative methods of increasing the efficiency of the doctors we have, making it possible for them to treat more people more effectively; in other words, improve the system through which medical care is delivered by increasing physician productivity.

Many of us in the Congress have worked and continue to work to provide adequate funds to meet the health needs of the country, but this is obviously only part of the answer. The other part has to do with the responsibility of the health professions themselves to develop and adopt new methods so as to increase the efficiency and productivity of the system.

I leave, of course, to the able and distinguished doctors who are scheduled to testify before your subcommittee, Mr. Chairman, any details about how the operation of present physicians could be more effective, and would be interested in their views on such approaches as group practice, health care teams using paramedical personnel, and the use of new technques involving computers and other electronic devices.

Another aspect of the shortage of health personnel all around the United States is the uneven geographical distribution of the people we now have in those professions, a shortage most acute in urban and rural poverty areas. Some means must be found to motivate more doctors and dentists to practice in such areas. One proposal in the Senate which would certainly appear to have merit would provide for total cancellation of indebtedness on health professions loans after 3 years' practice in such areas by the loan recipient.

Innovations in curriculum are also proposed to help bridge this now so obvious gap in medical personnel. To that end, for example, Mr. Chairman, the new University of Missouri-Kansas City School of Medicine plans to offer a full premedical and medical curriculum in 6 years instead of the usual eight by the method of operating on a longer 48-week school year.

In closing, Mr. Chairman, the leadership role which medical schools should exercise in their communities is well illustrated by some of the planning for the Kansas City school. That school intends to work closely with the Kansas City model cities program and the OEO neighborhood health center, as well as other local medical facilities, so that students receive experience in the entire range of community health needs.

Let me express confidence that Americans can and will meet the challenge of providing adequate health care for all of our citizens. To accomplish that goal, however, will require the joint efforts of

government at all levels in conjunction with the medical profession; and, let's be frank about it, the expenditure of far greater funds than have been allocated in the past and are allocated now.

This investigation by this subcommittee, under its able chairman, can only be instrumental in pointing out the right road down which we should travel, and I am confident the subcommittee will broaden its inquiry to cover the overall question of how better health care can be delivered to our citizens at a more reasonable cost.

Mr. Chairman, it is my understanding that you also plan hearings on this all-important subject in Kansas City later this week. Unfortunately, longstanding engagements make it impossible for me to be there at that time and, therefore, I would respectfully request of you, sir, that this statement be placed in the record in the manner you decide most appropriate at the time of your Kansas City hearing.

I deeply appreciate this opportunity to present my thoughts on this important matter.

Senator EAGLETON. Thank you very much, Senator, for an excellent statement, which I think covers the area very well in terms of what we are focusing on here, the shortage of manpower, its distribution, inducement to go into the medical field, et cetera. I assure you your statement will be made a part of the Kansas City hearing record, as well.

I would like to invite you, Senator, to join us here to hear as many of the witnesses as your time will permit.

Let me just add some figures in support of a couple of statements you made so that we have this in the record.

You point out on page 4, of your statement that:

More money for student support is also needed if medicine is not to become a profession that only the rich can afford to enter.

We have the figures, and I will read them into the record, for the student loan program which assists students of less than affluent financial means in receiving a medical education. The moneys appropriated for these programs for recent years are as follows:

For the fiscal year 1968, $26 million; for fiscal year 1969, again $26 million; sadly, for fiscal year 1970, $15,900,000, a reduction of $10,100,000 between fiscal 1969 and fiscal 1970. President Nixon has recommended a further cut for fiscal 1971 down to $12 million.

I am happy to say that the House Appropriations Committee did not accede to the request and has appropriated $22 million for fiscal 1971, but, in any event, if that is the ultimate figure, it will still be less than the amounts appropriated in fiscal 1968 and fiscal 1969, even though the statistics indicate our needs are even greater, more severe, and more acute. We are now funding the programs at a lesser level which, to me, just does not make good sense.

Finally, I want to insert an article in the record that appeared in the Washington Post a day or so ago about the loan forgiveness provisions of the student loan program. If students who avail themselves of the loans, on completion of their medical education, locate themselves in poverty areas or areas with a shortage of doctors, their medical loans that financed their education will be forgiven. It was deemed to be an inducement to attract medical graduates into areas where medical manpower is so desperately needed.

However, this program has been in existence now for 5 years and only seven medical students, seven in the entire United States, have availed themselves of this loan forgiveness feature. Either the program is not well known or it is not sufficiently attractive or something. We want to find out, because seven doctors, considering the desperate shortage in some of these areas nationwide, is a miniscule number, indeed.

Thank you very much, Senator. Would you care to join us here? Senator SYMINGTON. I would be very happy to do so, sir. I would like to hear what a Congressman has to say on this matter.

Our next witness will be another gentleman named Symington and, in this instance, the Honorable James W. Symington, a Congresman from the Second Congressional District, St. Louis County. Congressman Symington.

STATEMENT OF HON. JAMES W. SYMINGTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSOURI

Mr. SYMINGTON. Thank you, Mr. Chairman.

Senator Symington, members of the staff, Mr. Chairman, your remarks opening this hearing today followed by the senior Senator's remarks really leave me very little to say. I find that I was going to cover many of the same points and, as usual, the Senate has done it more succinctly than the House.

The authorities do seem to agree that the United States needs 50,000 more doctors now than it has. You mentioned the figure of 9,000 dentists. I was given a figure somewhat in excess of that; 150,000 more nurses; 266,000 more people in the allied health professions, including 45,000 in environmental health, the idea being that people who don't get sick don't have to be cured.

As both you and your senior colleague noted, it is more than a numerical problem; it is one of maldistribution with medical personnel being located in the eastern and affluent suburban areas around the country.

Senator Symington noted President Nixon's comments last year to the effect that we face a massive crisis in the field of health care. Yet, given these obvious shortages in crucial health manpower, the administration requested $500 million less than the American Association of Medical Colleges recommended as an appropriation for the National Institute of Health for fiscal 1971. That request was $2 billion and the administration request was $1.5 billion, reflecting, I should think, a 25-percent lower estimate of the massiveness of the crisis or of the ability of the country to face it at this time.

Fearing a Presidential veto, the House of Representatives defeated an amendment to the proposed Labor-HEW bill which would have come closer to the AAMC's estimate. The $400 million in added funds which the House voted down in roughly equivalent to the cost of 5 days of the Indo-China war.

We are beginning to see here in St. Louis the cost of these misplaced priorities. St. Louis University School of Dentistry, some of whose representatives I know are here today, graduated its last class in June of this year. Missouri Baptist Hospital's School of Nursing faced the prospect of closing after 73 years because it will not receive

a $340,00 grant for construction which would have been part of the added $400 million which was not approved. It seems to me that we don't remedy health manpower shortages by closing down schools.

The dean of the St. Louis University Medical School has noted that the tuition raises necessitated by cutbacks in Federal funds, coupled with decreased appropriations for student loans are, as he puts it, "pricing the poor boys out." St. Louis University has been attempting to meet both numerical and distribution manpower needs by increasing its enrollment and offering opportunities to minority students. If more funds were available to these schools and to the Nation at large, what are some of the programs that might benefit?

We could follow the AMA's suggestion that greater public outlays be used to train medical practitioners and a smaller percentage allocated to pure research. Incentives could be offered to encourage more medical students to enter general practice, supplementing the specialists and enhancing the availability of the family practitioner to serve a larger number of patients, especially in less affluent areas.

Programs like the Medex experiment at the University of Washington where personnel trained by the armed services receive further development in their health-oriented skills could be expanded.

The Allied Health Professions Personnel Training Act, passed by Congress on July 30, would provide assistance for construction of facilities to train allied health professionals, as well as grants and traineeships to develop better methods for teaching health technologists. Such paraprofessionals could relieve doctors of some of the more routine aspects of patient care.

If Federal support were available, universities could establish demonstration centers, attached to their medical schools, which could train and place allied health workers, such as pediatric nurse practitioners, physicians' assistants, dental hygienists. Paraprofessionals, yes, such as these, would, along with doctors, constitute health teams, serving a threefold purpose their own education, experiments with new divisions of medical labor, and community service, helping to insure a better distribution of health care. Such a plan might be incorporated with AMA President Dr. Walter Bornemeier's suggestion that the Government finance ghetto clinics to be operated by medical societies, medical schools, and private doctors.

I will be, Mr. Chairman, cosponsoring further legislation along the lines of the legislation to which you referred, and the pending legislation now in the Senate, to encourage physicians, dentists, optometrists, and other medical personnel to practice in medically deprived areas. Perhaps the inducements could be increased in some fashion and, as you say, by repaying the loan the student incurs while in medical school if he agrees to practice for 3 years in a location where a critical health manpower shortage exists.

Besides these specific measures geared toward meeting immediate manpower shortages, a comprehensive national health plan to deal with the problems of recruitment, training, and distribution ought to be able to assure that medicine in America would move beyond the crisisresponse phase. I would hope that by 1976 we could have a new "spirit. of '76" of reasonable independence from the health worries that plague America today.

« PreviousContinue »