limit the authority of the Department to the support of educational programs of excellence. We strongly urge that as a minimum project grant support be restricted to educational programs with at least 20 students. This is the requirement under existing law.

We would also suggest a provision for continuing education in addition to programs for training and retraining of allied health personnel. The contributions of research and automation in clinical laboratories, including the present interest in multiphasic screening programs or laboratory profiles, are changing the patterns of laboratory work to such a degree that it is necessary for the medical technologist to participate in continuing education programs to keep abreast of these rapid advancements.

I would also like to emphasize the importance of the provisions of S. 3586 for student loans and scholarships. Such financial assistance is now available to students in medicine, dentistry, nursing, pharmacy, podiatry, optometry, veterinary medicine, and osteopathy. It is no less important to students of the allied health professions.

In testifying before the Committee on Ways and Means of the U.S. House of Representatives, on November 6, 1969, by Daniel W. Peettengill, vice president of Aetna Life and Casualty stated "while financing health care is a serious problem, the fundamental problem facing the Nation today is the inaccessibility of quality health care for much of the population and the unacceptability of some of the care that is available."

Dr. Roger O. Egeberg, Assistant Secretary of Health and Scientific Affairs, emphasized this view when he said it would be a mistake to introduce any unitary national system for health care payments before the Nation had reformed its system of health care. The extra burden of demand would swamp an already overtaxed system of medical care.

The reformation of the present system must include a greater use of allied health professions. The estimate that has been stated many times is that it would take 10 years to produce the number of physicians needed to meet today's medical needs, not the needs 10 years from now. Therefore any new system must include greater utilization of all the allied health professionals.

In the case of medical technology, one of the allied health professions that could assist in alleviating the present critical shortage situation in the field of health services, there are a sufficient number of programs for those entering this field.

The Journal of Medical Education of the American Medical Association of November 24, 1969, reports a total of 787 accredited programs for the training of medical technologists.

These programs have the capacity for 8,221 students, yet only 5,055 were enrolled in 1968-69. These programs are filled to about 60 percent of their full capacity.

Thus it is apparent that financial assistance for students must share equal priority with new construction and institutional support in formula and project grants in the interest of high quality educational

programs.

At the present time the financial aid in the form of scholarships in the allied health professions give assistance to about 1 percent of the students who qualify by virtue of financial need as well as ability. Students need assistance not only to enter these programs, but to remain in them.

Mr. Chairman, I want to thank you again for this opportunity to present the views of the American Society of Medical Technologists. The CHAIRMAN. Thank you very much for this contribution here, Mrs. Spraberry. On page 5, you say there are a total of 787 accredited programs. Do you mean 787 different disciplines or do you mean there are that many programs accredited in that many different universities? Mrs. SPRABERRY. That many programs in medical technology alone. The CHAIRMAN. You mean that many different professionals. Mrs. SPRABERRY. Different schools.

The CHAIRMAN. You are not referring to that many different disciplines, are you?

Mrs. SPRABERRY. No, sir. One discipline.

The CHAIRMAN. There are 787 schools of medical technology. You have only 5,055 students enrolled?

Mrs. SPRABERRY. Right.

The CHAIRMAN. According to my arithmetic, that is approximately 6.5 students per program?

Mrs. SPRABERRY. Some of the programs will have only one student and this is one of the major problems.

The CHAIRMAN. We have a limit here under the existing Federal law. You must have 20 students in the program for it to be accredited. If your national average is only 6.6 students per program, how are we going to get money in there if we limit this and apply it only to programs where they have 20 students?

Mrs. SPRABERRY. I would like to respond to that by first mentioning something that Dr. Hamilton stated in relation to teaching hospitals. Most of these schools are in teaching hospitals affiliated with training centers. These students can receive assistance through the training center. I think it is a matter of understanding how these programs actually work.

The 787 schools are located in teaching hospitals that are affiliated with university centers or junior colleges.

The CHAIRMAN. Of course you have only 105 medical schools in the United States. So you would have to go beyond medical schools to have the 787 different places where they are accredited, wouldn't you?

Mrs. SPRABERRY. The 20 students does not refer to students enrolled in the clinical year but to the total number of students in the training center, not the total number in one particular class.

It is a matter of faculty resources that one must consider.

The CHAIRMAN. If you have 787 accredited programs how many schools would that be? That would not be 787 different medical schools and accredited training centers?

Mrs. SPRABERRY. That is 787 schools of medical technology.

The CHAIRMAN. And you now have that many accredited and 5,055 students enrolled. That still gives you an average of only 6.5 students now enrolled.

Mrs. SPRABERRY. This enrollment in the 787 is only the clinical year, the fourth year of training. This is the problem that you will have to understand. There are 3 years prior to this.

The CHAIRMAN. I am wondering with the 20 students limit how any school is getting any money now, with the average of 6.5?

Mrs. SPRABERRY. We are talking about 20 students over a 4-year program, not 20 students in 1 year. Twenty students enrolled in the training center.

The CHAIRMAN. During any 4-year period. It seems to me that your own figures negate your opposition to the reduction. Perhaps we should have some limit here rather than one. You point out one, two or three could receive a grant. Perhaps we should have some different minimal number. It seems to me that the statistics you give us would show that we need to revise the 20-student formula.

Mrs. SPRABERRY. I think I am not getting my point across to you. The CHAIRMAN. I am getting your point that if you had 20 students attending in 4 years that would apply, you would have a 6.5 average

per year.

That is normally the way we count enrollment in American educational institutions.

Mrs. SPRABERRY. The 20 students of a training center would not refer to the students just enrolled in medical technology. The 20 students would refer to students enrolled in allied health professions which include a variety of other disciplines.

The CHAIRMAN. You're referring here only to medical technology requiring a bachelor's degree.

Mrs. SPRABERRY. That is right.

The CHAIRMAN. Yes, that clarifies it. Thank you. But you do oppose extending this to teaching hospitals?

Mrs. SPRABERRY. No, I think students enrolled in teaching hospitals could be eligible for scholarship and loans, because they are still under the university or the college training program.

The CHAIRMAN. You do not oppose then the extension of the law to teaching hospitals?

Mrs. SPRABERRY. Not as long as these teaching hospitals are affiliated with educational universities.

The CHAIRMAN. I take it that there are 787 combination either medical schools or teaching hospitals that are affiliated with a medical school or with another school that is authorized to teach, a college or junior college, that is authorized to teach allied health personnel?

Is that the distinction you would draw, whether this hospital was allied with a teaching institution per se?

Mrs. SPRABERRY. That is right. Some of these 787 schools are not affiliated with educational institutions. Some of these accept one student or only enough students to fulfill their own employment needs.

The CHAIRMAN. I invite you to file a supplemental showing how many of these are medical schools, how many are hospitals and allied with junior colleges and give us a breakdown of the 787 that you considered in connection with your recommendation that this law not be extended as it is now drawn to apply only to a hospital where they do teach these courses, but a hospital not affiliated with some educational institution.

45-552 0-7011

Mrs. SPRABERRY. I will be glad to.

The CHAIRMAN. I would like to have a complete breakdown of that. (The document referred may be found in the files of the subcommittee.)

The CHAIRMAN. Thank you very much. That completes our hearing for today. The hearing is recessed until 10 o'clock tomorrow morning. Thanks to all of you for your patience and your contributions here. (Whereupon, at 12:30 p.m. the subcommittee recessed, to reconvene at 10 a.m., Wednesday, May 20, 1970.)

HEALTH TRAINING IMPROVEMENT ACT OF 1970

WEDNESDAY, MAY 20, 1970

U.S. SENATE,

SUBCOMMITTEE ON HEALTH

OF THE COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C. The subcommittee reconvened at 10:20 a.m., pursuant to recess, in room 4232, New Senate Office Building, Senator Ralph W. Yarborough (chairman of the subcommittee) presiding.

Present: Senators Yarborough (presiding) and Dominick.

Staff members present: Robert O. Harris, staff director; and John S. Forsythe, counsel; James Babin, professional staff member; and Jay B. Čutler, minority counsel to the subcommittee.

The CHAIRMAN. The Subcommittee on Health of the Senate will come to order. Hearings will be resumed on the three bills dealing with the general subject of training personnel in the allied health professions.

Hearings are resuming following the first day of hearings yesterday. The first witness listed for today is Dr. Abraham Bergman, director of outpatient services, Children's Orthopedic Hospital and Medical Center, Seattle, Wash.

Dr. Connelly is accompanying Dr. Bergman. Dr. Connelly is chairman of the committee on manpower of the American Academy of Pediatrics of Boston, Mass.

Good morning, gentlemen. You may proceed in your own way. STATEMENT OF DR. ABRAHAM B. BERGMAN, DIRECTOR OF OUTPATIENT SERVICES, CHILDREN'S ORTHOPEDIC HOSPITAL AND MEDICAL CENTER, SEATTLE, WASH.; ACCOMPANIED BY DR. JOHN P. CONNELLY, CHAIRMAN, COMMITTEE ON MANPOWER, AMERICAN ACADEMY OF PEDIATRICS, BUNKER HILL HEALTH CENTER, BOSTON, MASS.

Dr. BERGMAN. Thank you, Mr. Chairman and Senator Dominick. I have a written statement for the record that I would like to insert in the record, but if I may, I would like to just briefly summarize it, sir, and make a few informal comments.

The CHAIRMAN. Fine. Your entire remarks will be printed, with the exhibit you have attached, in the record at this point.

(The documents referred to follow :)