PREPARED STATEMENT

We, therefore, urge this subcommittee to appropriate $50 million for fiscal year 1992 and include report language urging the development of rehabilitation training grants for rehabilitation personnel in regions that are more adequately funded. The level of funding recommended by the Consortium for Citizens with Disabilities is $50 million, and it is the level being recommended to the authorizing committees that are considering the extension of the Rehabilitation Act.

Thank you for the opportunity to present this testimony. I would be glad to answer any questions you have.

[The statement follows:]

STATEMENT OF DIANE GREYERBIEHL

Mr. Chairman, there continues to be an erosion in training funds for persons who serve individuals with disabilities. This erosion is undermining the knowledge and skill level of professionals serving persons with severe disabilities and threatens the entire fabric of our service delivery system of rehabilitation facilities and programs. The passage of the Americans With Disabilities Act will increase the need for professionals who can train and place persons with disabilities into community jobs. There are also relatively new initiatives such as supported employment which desperately need trained professionals to insure quality programs that will have long term success. These new programs will place ever increasing demands on rehabilitation facilities and other service providers. The current erosion in the foundation of trained professionals endangers these initiatives.

The educators of community based program personnel are a vital link in the integration of persons with disabilities into the work force of our nation. I am here today as vice president of the Association for the Education of Rehabilitation Facility Personnel (AERFP) to request that adequate funds be appropriated to enable us to respond to the ever greater training needs of the programs we serve.

The inadequate state of funding for training of rehabilitation personnel needs your immediate attention.

HUMAN RESOURCE DEVELOPMENT

An analogy to what American businesses spend on human resource development compared to rehabilitation facilities may help in showing how far behind we are. Let us assume for a moment that rehabilitation facilities are businesses rather than social service organizations. Rehabilitation facilities are a $2 billion a year industry that serves more than 1,600,000 individuals with the most severe disabilities. There are over 7,000 community based rehabilitation facilities, including day activity programs. These facilities employ more than 150,000 professional staff. It is estimated that one third of the expenditures under the state/federal rehabilitation program are for services in facilities. This is a significant industry by any standards.

Industries of this size should spend a significant amount on human resource development. Businesses know that you have to constantly train and retrain employees to insure a work force that knows the latest technology and best methods of doing their job. Human resource development also insures that the long term needs of the company can be met. They have found that this pays dividends in areas of efficiency, quality, turnover, and overall worker productivity. These same outcomes are the goal of the human resource development programs for rehabilitation facilities.

RSA training programs provide the foundation for preparing 150,000 personnel working in rehabilitation facilities. Qualified personnel are also at the heart of services delivered to the 1.6 million persons served in rehabilitation facilities. This presents a massive problem of HRD for rehabilitation facilities and RSA.

A professor at the School of Industry and Labor at Cornell University has told us that most American businesses spend between 2 and 5 percent of their payroll budget on human resource development; to train its workforce to do their present job, to upgrade and refine this manpower resources, and to invest in new personnel capacities in order to assure its market edge. This level of investment in HRD is appropriate because of the return such investment has on business productivity and effectiveness.

For the industry of rehabilitation facilities this means that between $40 million and $100 million should be spent on human resource development. Currently the Rehabilitation Services Administration is spending approximately $4.9 million on facility related training programs. This is less than one quarter of one percent of the estimated gross income of facilities. Admittedly these facilities pay for some training on their own. But even assuming they are able to match the federal expenditure, they still come up woefully short of what needs to be spent. This provides limited potential to address the Americans With Disabilities Act and the need to provide qualified workers to the American workforce.

ADEQUATE FUNDING IS NEEDED TO OVERCOME PAST NEGLECT

I am here today to request that adequate funds be appropriated to enable us to respond to the ever greater training needs of the facilities and programs we serve. The attached chart graphically illustrates the critical state of funding for rehabilitation personnel training. If funding is continued at the current level of $33.53 million we will have only $3 million more than we had in 1979. When you take inflation into consideration we are 65 percent behind where we were twelve years ago. We need to reverse the trend of minimal increases over the past several years. It is essential to overcome this neglect because these are workers who will fill the workforce and meet the employment goals of ADA. We urge this subcommittee to appropriate $50 million for fiscal year 1992. This is the level recommended by the Consortium for Citizens with Disabilities and it is the level being recommended to the authorizing committees as they consider a one year extension of the Rehabilitation Act.

The lack of adequate funding over the past several years is having a real impact on the education community's ability to train personnel to provide these rehabilitation services. For instance many rehabilitation facility training programs have been phased out due to a lack of funding.

SUMMARY

Facility manpower shortages and training needs necessitate allocating funds to train rehabilitation personnel in facilities to best serve persons with disabilities. Without upgrading the skills and knowledges of current and future staff, the options afforded to persons with severe disabilities will be restricted. This would also deny the workforce the unique skills and commitment of people with disabilities. There is currently only $4.9 million used by the Rehabilitation Services Administration in training professionals in rehabilitation facilities. This is inadequate to fund this important need. We advocate a planned program to meet these facility training needs through the training program within the Rehabilitation Services Administration. There needs to be national coverage on a regional basis in the areas of rehabilitation facility administration, supported employment, rehabilitation workshop and facility personnel, and vocational evaluation and work adjustment. These training categories are critical to the improved delivery of rehabilitation facility services throughout the United States and to the quality of life and choices afforded to persons with severe disabilities.

Training rehabilitation professionals is but a part of a much larger process AERFP supports all of the other parts of the Rehabilitation Act. We urge full funding of basic state grants, supported employment, Projects With Industry and NIDRR to insure that quality services are available to as many persons with severe disabilities as possible.

Mr. Chairman, we urge the subcommittee to recommend funding of $50 million for fiscal year 1992 and include report language urging the development of regional training grants for rehabilitation facility personnel preparation.

Thank you very much for this opportunity to present this testimony. I will be glad to answer any questions you may have.

Senator BUMPERS. Diane, I can tell you almost categorically that we are not going to be able to go from $33 to $50 million in 1 year, though your needs are legitimate. The Americans With Disabilities Act obviously increases the demand for the kind of training your organization provides. We will certainly give your request for report language serious consideration, and I hope we can increase your budget enough that it will be meaningful to you.

Meanwhile, your training program is up for reauthorization. Are you going to be making recommendations to the authorizing committee for these regional training grants?

Ms. GREYERBIEHL. Yes.

Senator BUMPERS. You will be?

Ms. GREYERBIEHL, Yes.

Senator BUMPERS. Diane, thank you very much.

Ms. GREYERBIEHL. Thank you.

Senator BUMPERS. I admire you for the work you are doing.

STATEMENT OF JAMES G. JONES, M.D., GREENVILLE, NC, AMERICAN ACADEMY OF FAMILY PHYSICIANS

Senator BUMPERS. In order to conserve a little more time, I am going to call four witnesses. If you will, all four of you come up and we will save a little time shuffling back and forth. Dr. James G. Jones of Greenville, NC, the American Academy of Family Physicians; Jim Kelehan, AARP Vote Coordinator, Fourth Congressional District of Iowa, American Association of Retired Persons; Michele

Best, American Society of Clinical Pathologists; Dr. Milford Maloney, president, American Society of Internal Medicine.

Welcome to all of you and, Dr. Jones, since you were the first one, please proceed.

Dr. JONES. Thank you, Mr. Chairman. Good morning. I am James Jones, past president of the American Academy of Family Physicians and a member of the National Advisory Council on Health Professions Education. More importantly I am a country doctor from North Carolina.

The American Academy of Family Physicians is a national organization representing over 70,000 practicing family doctors, residents, and students interested in family medicine. And I am very grateful for this opportunity to appear before the subcommittee and to discuss with you appropriations for fiscal year 1992 for family practice education.

The academy very much appreciates, Mr. Chairman, your recognition of the need for, and the contribution to, the specialty of family medicine has made to the Nation's health care. Assistance through Federal grants targeted for family practice residencies and departments of family medicine help maintain and train specialists in family medicine and increase access to valuable quality health care to American people. Your continued support at this time is particularly critical as we face a budget which proposes to eliminate support for family practice education.

Approximately 93 percent of America's family doctors are engaged in direct patient care serving a wide range of the Nation's population from its children to its elderly, from its urban to its rural areas. Because of the wide multiple disciplinary training of family physicians, we are able to care for the majority of problems that present to offices of family doctors and are particularly adaptable at the diverse needs presented in various geographic areas. As a matter of fact, 85 percent of all visits are resolved by the family doctor without need for referral or consultation.

As our population ages 2 percent per year up to the year 2020, as it is predicted, the need for family doctors will increase in caring for the elderly. We provide more of that care than any other medical specialty. With the increasing needs for the treatment of HIV infected individuals and the mushrooming of the managed health care system, all of these are going to place heavy demands for an increasing number of family physicians.

And while the demand for family physicians is high and growing, the supply is not keeping pace. In fact, between the years of 1985 and 2000, the U.S. population is predicted to increase by over 12 percent, and by contrast, the number of family doctors by only 9 percent. Data regarding the number of physicians selecting the specialty of family medicine has declined in recent years. This is particularly bothersome to us. The percentage of medical students planning to go into all fields of primary care have fallen from 37.3 percent in 1982 to 23.6 percent in 1989, and we believe it is cause for alarm.

In 1991 with the help of this subcommittee, family practice was funded by Congress at $36 million for residency programs and $6 million for our departments of family medicine, and we are grateful

for that. But we believe that the job is far from being done, and we need your continued help.

Accordingly, we are requesting and I know from your warning early on, Mr. Chairman, that it is somewhat precarious to ask for increases, but because of the urgency of this problem, we are going to ask that there be a doubling of the funding for family medicine education to $80 million for the residency programs and $14 million for the departments of family medicine. These funds would provide the necessary doctors that we believe are critical to meet the health care needs of the American people.

PREPARED STATEMENT

We also believe that there ought to be some consideration given to funding the new Agency for Health Care Policy and Research, and we strongly suggest that a consideration be given at this critical time to increase their research appropriations by an additional $20 million so that we can do the community-based health research, which has not been done by the NIH and other kind of research folk.

Senator BUMPERS. Thank you, Dr. Jones.

STATEMENT OF JAMES G. JONES

FUNDING FOR FAMILY PRACTICE TRAINING PROGRAMS

I am James G. Jones, M.D., Past President of the American Academy of Family Physicians and a member of the National Advisory Council on Health Professions Education. The Academy is the national medical specialty society representing over 70,000 practicing family physicians, family practice residents and medical students. I am pleased to have the opportunity to appear before this committee to discuss with you appropriations for fiscal year 1992 for family practice education.

The Academy is appreciative of your recognition of the need for and the contribution of the specialty of family practice to the nation's health care. Assistance through federal grants targeted to Family Practice Residencies and Departments of Family Medicine help to train more specialists in family medicine and increase access to quality health care for Americans. Your continued support is critical as we again face a budget which would eliminate support for family practice training, as proposed by the Administration.

THE NEED FOR MORE FAMILY PHYSICIANS

Approximately 93 percent of family physicians are engaged in direct patient care, serving the range of the nation's population from its children to its elderly, from its urban to its rural areas. It is these physicians who make the initial diagnosis and provide the continuum of care for patients with a variety of health and social problems, such as teenage pregnancy, infant mortality and human immunodeficiency virus, as well as problems involving occupational and environmental health. Because of their multidisciplinary training, family physicians are able to care for the majority of the problems presented in their offices and are particularly adaptable to the diverse needs presented in the various geographic areas. On average 85 percent of all visits are resolved by the family physician without referral or consultation.

Graduates of family practice programs serve the medically needy in remote rural areas as well as impoverished inner-city areas. Family physicians locate in shortage and rural areas in larger proportions than other medical specialties, thus helping to address the national problem of geographic maldistribution.

As the demographics of the U.S. population change, many more family physicians will be needed and must be trained. The population 65 years of age and over will increase about 2 percent a year between now and 2020. These elderly will require a wide range of health care services, including preventive, primary, long-term, hospice, and rehabilitation care. Over the next decade there must be a substantial increase in the number of family physicians to meet the demand for health care.