there are great-that the genesis of some of the problems we see overseas lies in some of our problems right here in America, and this committee, I think, through the years, and the activities of its distinguished chairman, Mr. Yarborough, will really go down in history as really making efforts to try to solve some of the problems in this country that are so severe and which really are going to help answer some of the questions and problems that the students have.

The CHAIRMAN. Í am very grateful that the people have given me the privilege of serving on this committee over 12 years.

Year before last, I was at the White House when President Johnson was signing one of the health bills. He turned to me and said 80 percent of health laws that help people go through that committee of

yours.

The Senator from Colorado has been on there for years. It is a great experience to attempt to be of service to American people.

I am not speaking for him. We may not agree on certain expendi

tures.

The next witness is Dr. Lester Burket, dean of the Dental School, University of Pennsylvania, and on behalf of the Association of American Dental Schools and the American Dental Association.

He is accompanied by Mrs. Diane McCain, American Dental Hygienists Association and, Miss Muriel Burnett on behalf of the American Dental Assistants' Association.

Dr. Burket, will you identify your colleagues?

STATEMENT OF DR. LESTER BURKET, DEAN, DENTAL SCHOOL, UNIVERSITY OF PENNSYLVANIA, ON BEHALF OF THE ASSOCIATION OF AMERICAN DENTAL SCHOOLS AND THE AMERICAN DENTAL ASSOCIATION, ACCOMPANIED BY MRS. DIANE MCCAIN, AMERICAN DENTAL HYGIENISTS ASSOCIATION; AND MISS MURIEL C. BURNETT, AMERICAN DENTAL ASSISTANTS ASSOCIATION

Dr. BURKET. Yes, sir.

Mr. Chairman and members of the committee, my name is Dr. Lester W. Burket. I am dean of the University of Pennsylvania School of Dental Medicine and am representing the American Dental Association and the American Association of Dental Schools.

With me are Mrs. Diane McCain, representing the American Dental Hygienists Association and Miss Muriel C. Burnett, representing the American Dental Association.

This is the first time these organizations have appeared jointly before a congressional committee. We do so today not only to conserve the time of the committee but to indicate to you that we share an identical concern and commitment to the Allied Health Professions Personnel Training Act.

At the beginning we wish to express our gratification and that all of the bills before you are directed toward extensions and improvement of the present law.

If we are to narrow significantly the present gap between need for dental care and ready accessibility of such care then we must greatly

increase the number of dentists and allied personnel who just give that care. To do this requires intensified support from all sources of the training facilities needed to teach the necessary number of dentists, dental hygienists and dental assistants and dental laboratory technicians.

As this committee well knows, the drive to produce more dentists is complicated by the time lag, as much as 10 years in duration between the planning stage of a new dental school and the year it graduates its first class is not unusual.

A time lag of such duration does not occur with supportive personnel in the dental field. In addition there is increasing understanding within dentistry of the fact that the hygienist and the assistant can and should perform additional functions.

Concentration of programs within the purview of the Allied Health Professions Personnel Training Act, then is both professionally and pragmatically desirable.

Certainly as these hearings are making clear, the need is great. The following facts demonstrate this with respect to dentistry.

At the present time there are some 18,000 full time or full time equivalent dental hygienists in practice. Since there are presently some 96,000 dentists engaged in chairside care, this gives a ratio of one hygienist for every five or six dentists. At a minimum the ratio ought to be one hygienist for every two dentists.

Given the increase in number of chairside practitioners this means that by 1980 we will need 56,000 hygienists.

It is estimated that some 8,000 of the hygienists currently in practice will still be pursuing a career in 1980. Thus 48,000 new hygienists must be graduated in the present decade. The current graduation rate however will give us only 23,000. The net deficit then is approximately 25,000.

The numerical shortage of trained dental assistants is even more severe. Presently there are some 103,000 dental assistants in practice, giving a ratio of approximately 1.1 dental assistants for every dentist.

It is agreed by those expert in the field that a minimally desirable ratio is two assistants for every dentist. By 1980 then we will need some 220,000 dental assistants. It is expected that some 55,000 dental assistants in today's work force will still be active in 1980; thus we need to graduate 165,000 during the coming 10 years.

Current graduating classes will give us 28,000 of this number leaving a deficit of 137,000.

Available figures for dental laboratory technicians indicate similar problems. We should today be graduating at least 700 technicians annually in order to meet the known needs we will be facing in 1980; in fact we are graduating barely half that number.

The financing required in the very near future if we are to have any hope of meeting the stated goals is obviously considerable. Dental hygienists can serve as an example of this.

In order to reach the desired ratio of hygienists to dentists by 1980 we should be graduating some 2,500 more hygienists a year than we are presently. This is the equivalent of 63 new, 2-year dental hygiene schools with 40 students in each class.

One time construction costs for 63 schools, excluding capital purchases, would range from $37 to $42 million. Annual operating costs would be some $200,000 per school or $12.6 million as an annual total for all 63 schools.

What we are citing, of course, are figures, total figures to which private sources, tuition payments and non-Federal public sources will contribute. Nonetheless we believe these illustrations indicate graphically the dimensions of the need to which the Health Professions Personnel Training Act must address itself.

Administration of the act, thus far, has not indicated an understanding on the part of the administrators of the seriousness of the situation.

Though the executive branch of the Federal Government has been most vocal about the need for redressing shortages in the auxiliary fields, its actions have lagged far behind its words, its appropriations have lagged far behind the present authorizations.

Appropriations for basic improvement grants, as an example, have been again barely half of the authorizations; those for construction have been little more than one-tenth of the authorizations.

As a result in fiscal 1969 of the 102 accredited dental hygiene schools then in existence 62 were eligible for basic improvement grants and received on the average $18,200 each and parallel figures for dental assisting are 20 of 100 schools with an average grant of $13,750 and for dental laboratory technology, 12 of 23 schools received some $11,000 each.

Such figures fall far short of what we believe the level of Federal participation should be.

Despite this paucity of funding, the dental auxiliary fields have managed to show significant growth, and I call to your attention the appendix to our statement.

(The information referred to follows:)

III. GRADUATION INCREASES NECESSARY TO MEET FUTURE NEED

[Present ratios: 100 dentists to every 17 hygienists and 101 assistants. Desired ratios: 100 dentists to every 40 hygienists and 200 assistants.]

1. Hygienists:

(a) Hygienists needed by 1980.

(b) Current hygienists expected to be still active in 1980

(a) Assistants needed by 1980.

(b) Current assistants expected to be still active in 1980.

220,000

55,000

165,000

28,000

3. Technicians:

(a) Technicians needed by 1980.

137,000

(b) Current technicians expected to be still active in 1980.

50,000

(c) Number of technicians who must be graduated in next 10 years. (d) Expectable graduates based on current rates....

21 500

28,500

5,000

(e) Deficit...

23,500

Dr. BURKET. Considerable credit for this, we believe, should be given to the universities, medical centers, non-Federal public authorities, and private health organizations.

More realistic Federal support is however essential if growth is to accelerate, much less continue. In addition to the contribution Federal support can make directly, experience with the Health Professions Educational Assistance Act clearly demonstrates that the very presence of a realistic level of Federal funds stimulates the States and private institutions to find ways to increase their participation.

It is we believe time for the executive branch of the Federal Government to aline its actions more closely with its exhortations. Renewal and extension of the law you are considering is an appropriate place to begin.

As we have noted, all of the bills before you offer extension and improvement of this law. They do differ, however, in a number of important ways. Our organizations would like if we may to suggest some guidelines that the committee may wish to consider when making its final choice as to the nature of the bill it will report.

The first guideline has to do with length of extension. Our organizations believe the law should be extended for 5 years, as provided in S. 3586.

A 1-year extension we understand is preferred by some on the grounds that it would bring this law into timing with the Health Manpower Act and thus permit an overall review and revision of all health field legislation at the same time.

The motivation is understandable, but surelv this possibility is not foreclosed by reason of a longer extension, and there is ample precedent throughout Federal legislative history for the revision of a law, where appropriate, prior to its expiration date.

On the more positive side, a 5-year extension gives forthright notice to all non-Federal agencies involved that the Federal Government appreciates fully the necessity for this program and is committed to it on a long-term basis. Such notice is always welcome.

It is especially important we think in this instance since the experience under the law thus far may well have given rise to doubt in some minds as to the dependability of the Federal intent.

A second guideline we would suggest is that the bill reported by the committee should contain specific funding levels for the various programs authorized.

It is this committee that has the membership and staff expertise in the area. It is this committee that holds hearings and receives testimony from outside experts.

The legislation it takes to the floor should be as precise as possible but not only to guide and inform the Senate but as a whole but also the Appropriations Committee that must subsequently vote funds to implement the programs. Dollar authorizations serve this purpose and ought to be included. In addition realistic dollar amounts again underscore the fact that Congress understands the dimensions and urgency of the problem.

The bills before you are similar in detaching basic improvement grant funds from other grant funds included in the law that are intended for specialized purposes. We agree with this and with the proposal that potential beneficiaries of special grants be broadened beyond just training centers.

The bills differ, however, in that one would place all special project funds into a single section. This has the virtue of simplicity but also the failing of obscuring the distinct nature of and vital need for these varied activities.

We would suggest that the committee separate these special purposes by category as is done in S. 3586, thus helping to assure that each will receive the attention it deserves during the appropriations process. We believe further that S. 3586 should be amended to require now that special project support be limited to educational programs that are approved by recognized accrediting agencies.

Two of the bills before you propose beginning some new programs not now in the law, such as scholarship grants, capital contributions loans and a revolving loan fund.

We urge the enactment of these programs and their establishment will provide a steady, stable source of financial support enabling talented young people of modest means to pursue careers in these health auxiliary fields where their ability and energy is so badly needed.

The most unsatisfactory situation being presently experienced by professional health school students with respect to the Office of Education is guaranteed loan funds makes us most dubious of suggestions that the students in the allied health field should also be forced to seek heln solely from that source.

There is an obvious, distinct, high-priority need for financial help to students in this area. We do not believe that the availability of such help should be tied to the unavoidable fluctuations of the national money market.

As a last comment on the Allied Health Professions Personnel Training Act, our organizations should like to make special note of the traineeship provisions of the law.

In many ways, continued and expanded support of this activity is the most critical aspect of the entire legislation. The production of more teachers and administrators is an essential key to a more generous supply of health care personnel.

Finally, before concluding our testimony the American Dental Association and the American Association of Dental Schools would like briefly to comment on the section of S. 3586 that would amend the Health Professions Educational Assistance Act.

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