The nursing program you mention comes under the Nurses Training Act.

Dr. LEE. Most of the people who go into these special fields such as medical technology begin to specialize after their second year in college, the third and fourth years when they take special courses related to these fields rather than the first 2 years where they get their general education.

Mr. ROGERS of Florida. I noticed, too, that you have a provision in the bill to increase the per diem here from $50 and $75 to $100 for the Council?

Secretary GARDNER. Yes; we have that.

Mr. ROGERS of Florida. Is there any reason why this is necessary? Mr. KELLY. Mr. Rogers, as you know many of the statutes which provide the compensation for members of panels and councils were established at the time that the Federal pay rates were considerably lower.

They were originally conceived as authorizing up to the highest levels in pay rates. We are now authorized to employ consultants at a figure I think of $98 a day which I think is the highest pay which can be made.

We have statutes that authorize this for newly authorized councils and not for the old ones. We are trying to make it uniform throughout all legislation.

The CHAIRMAN. Mr. Younger.

Mr. YOUNGER. I just want to get my oar in on the junior colleges. Actually you are going to be tremendously short in your facilities for training. Many of the junior colleges are going on up now to the 4-year degree. You can't just say a junior college is the old classification.

We have one that used to be called a junior college which changed its name and they are working on up to the 4-year course. They have good facilities to furnish nurses training. I think we have to use all of the facilities, not part of them.

That is all.

The CHAIRMAN. Mr. Springer.

Mr. SPRINGER. I have no questions.

Mr. CHAIRMAN. I would like to again state that we do have the Vocational Education Act which comes under another committee of this Congress. That act provides this vocational training and turns out the people who actually get into the working areas.

I want to thank all you gentlemen for coming and contributing to this program. You have done an excellent job. This concludes our hearings until tomorrow morning at 10 o'clock.

Secretary GARDNER. Thank you, sir.

(Whereupon, at 12:10 p.m., the committee recessed, to reconvene at 10 a.m., Wednesday, March 30, 1966.)

ALLIED HEALTH PROFESSIONS PERSONNEL

TRAINING ACT OF 1966

WEDNESDAY, MARCH 30, 1966

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met at 10 a.m., pursuant to recess, in room 2123, Rayburn House Office Building, Hon. Harley O. Staggers (chairman) presiding.

The CHAIRMAN. The committee will come to order.

Yesterday when the committee adjourned we were having hearings on H.R. 13196, Allied Health Professions Personnel Training Act. Resuming this morning, we will have as our first witness Dr. Samuel Martin, provost of the University of Florida, Gainesville, Fla., representing the Association of American Medical Colleges. Martin, I see you have an associate with you. Will you identify him and then you may start in with your testimony. You may present your statement in its entirety in the record and summarize it or do as you wish.

Dr.

STATEMENT OF DR. SAMUEL P. MARTIN, PROVOST, THE UNIVERSITY OF FLORIDA, GAINESVILLE, FLA., ON BEHALF OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Dr. MARTIN. Mr. Chairman and members of the committee, my name is Samuel P. Martin. I am provost of the University of Florida, which is located in Gainesville, Fla. I appear today in behalf of the Association of American Medical Colleges, a voluntary, nongovernmental body, which includes in its membership all of the accredited schools of medicine in the United States.

I am grateful for this opportunity to present our views on H.R. 13196.

This bill, Mr. Chairman, involves two separate and quite distinct proposals. The first suggests measures designed to increase the number and quality of medical technologists and personnel in other allied health professions. With this proposal and the measures suggested herein, our association is in wholehearted agreement. It has our enthusiastic support.

The second proposal in the bill has to do with basic changes in the ongoing program of loans to students of medicine, dentistry, nursing, and other health professions. For these suggestions, our reaction cannot be called enthusiastic.

I am not going to read the testimony. I prepared this for you. I would just like to speak for a few minutes on this particular problem. You are acutely aware, I am certain, of the problem that we face in the area of health. In the last 50 years there has been a marked shift from the acute disease to the chronic diseases, diseases which are involved in taking considerable toll of our population.

In this room every one of us on a statistical average will have two chronic diseases. This has been shown by a study done by the Commission on Chronic Illness. Half of those diseases will be of a substantial nature and half of these that are of a substantial nature could be prevented with adequate care given at the proper time.

Therefore, I think you in Congress have recognized the gravity of this wave of chronic illness and you also recognize the need for intervention into chronic illness. So, you have supported patient care and in this legislation you are supporting training in preparation for a cadre of people to approach this problem.

In the training you have supported the physicians in the past. This bill, as I see it, supports the allied health professions. When one looks at the allied health professions one divides them into two large groups, one group that deals with theory and skill and applies theory and skill to the problem.

The other group is people who apply skill to a problem. One group could classify themselves as technologists. The other as technicians. This bill supports the training of the technologists and more importantly I feel this bill has provisions for training teachers in this field because if we are going to meet our need we must train teachers.

Section 781 to section 794 is well designed to cover support construction, it covers support, basic support of these institutions, and I think more importantly it has a place for special support whereby these health professions can come together, develop common core curriculums and even develop adequate training programs so that we can facilitate training larger numbers of these very skilled people who can help us in the care of patients.

Again, the advanced traineeship I think is particularly important because of our great need for teachers and the competition that education has with the work situation for the teachers.

On page 18 of the bill we deal with the forgiveness features of the bill. I think these are very good. The forgiveness feature has never worked very well with the medical student because of his high earning capacity once he leaves. We in medical education are acutely concerned as to how we can get the doctor to the outlying individual and see that this individual gets care.

It would be our feeling that if we could extend it to the health related personnel there would be a great encouragement to get health related personnel into these areas, and by putting health related personnel in the area we would in turn make it an attractive situation for the physician.

A physician has learned to use these people and have them help him with care, and when he goes to an isolated area he very frequently does not have any of these people to help him, and therefore he turns to an easier situation where health personnel are available.

So that I think consideration should be given to the forgiveness feature to the health related personnel, because we believe in the long run this will help the people in the related areas.

Now the second part of this deals with the present financing and source of loans.

In addition to being a provost, I am a director of a bank, so that when I noted this bill I immediately started my tour of the banking directors about the possibility of picking up the older paper and extending new credit, and I find that, as you well know, sources of money in banks there are great demands on this, and it will take us considerable time to develop a reservoir of credit to transfer this to private banking.

Being a bank director I might say that I have an interest in its being ultimately in the private sector. I think there are certain problems, that there is so much administrative work with these small loans, that you might even in the long haul, increase the cost of making these kinds of loans by passing it to the bank.

But the association would agree with the position taken by the American Council on Education when they testified about the forgiveness-about the loan feature in the education bill, and that we feel it would be catastrophic to pass this feature at this time, not giving us time to find sources to finance these students from a private

source.

This is the essence of my response. I want to thank you very kindly for giving me the opportunity to appear here. (The complete statement of Dr. Marti i follows:)

STATEMENT OF SAMUEL P. MARTIN, PROVOST, UNIVERSITY Of Florida

Mr. Chairman and members of the subcommittee, my name is Samuel P. Martin. I am provost of the University of Florida, which is located in Gainesville, Fla. I appear today in behalf of the Association of American Medical Colleges, a voluntary, nongovernmental body, which includes in its membership all of the accredited schools of medicine in the United States. I am grateful for this opportunity to present our views on H.R. 13196.

This bill, Mr. Chairman, involves two separate and quite distinct proposals. The first suggests measures designed to increase the number and quality of medical technologists and personnel in other allied health professions. With this proposal, and the measures suggested therein, our association is in wholehearted agreement. It has our enthusiastic support.

The second proposal in the bill has to do with basic changes in the on-going program of loans to students of medicine, dentistry, nursing, and other health professions. For these suggestions, our reaction cannot be called enthusiastic. The facts of fiscal life in this year of ever-tightening credit force us to view these suggested changes in a highly successful program with some trepidation.

Turning now to the first point, we would express our agreement with the administration's contention that our country is faced with a decided shortage of medical and health-related personnel-a shortage which cannot be met without prompt and effective Federal assistance to those institutions responsible for training such personnel.

There is no doubt but that we are short physicians. Our institutions, with your help, are doing their level best to remedy that situation. Nevertheless, with the constant growth of new knowledge and the consequent growth of new demands on the profession, we will not be able to meet the need for more physicians fully in the foreseeable future. It is of tremendous importance that the skills of the physicians we have and the many more physicians we will have be utilized in the most efficient ways possible.

This, gentlemen, means that we must greatly increase the available supply and quality of medical technologists and of people in allied health professions at both professional and technical levels. When we make available to the individual physician the optimum number of health-related personnel to round out his health services team, we confer upon him additional sets of arms and legs and ears and eyes. We enable him to treat many more people and to treat them better. enable him to husband his resources and take on personally only those tasks which require his peculiar skills and arts.

We

Sections 791 through 794 of the bill before us seem well designed to increase the number and quality of health-related personnel. The programs of construction grants, basic improvement grants, special improvement grants, and grants for the development of new methods parallel quite closely similar programs already in existence for the training of medical personnel.

The latter programs have proved both effective and acceptable to the profession, the schools, and the public. The newly proposed programs should prove equally satisfactory. We urge their enactment.

We are here asking a group of schools, many are new and most of them woefully underfinanced, to take on new and heavy burdens in the national interest: to meet a serious national problem. If the schools agree-and I am sure they will though the undertaking means additional headaches tempered only by the satisfaction of responding to the country's need-if the schools agree then Government must realize that it too is entering into a commitment. Congress should make a moral commitment to continue to defray its share of the costs of school expansion not just during the year when the Congress enthusiastically endorses the program but through those many years when the schools will be carrying their unglamorous burdens. Short of complete national fiscal emergencies, these sort of commitments must be kept.

Mr. Chairman, I have mentioned three of the four programs through which the bill proposes to increase the number and quality of health-related personnel. I have not mentioned the program of traineeships for the advanced training of such personnel to serve as teachers, as supervisors and administrators or to serve in new specialities. With this program we are also in hearty agreement. I single it out merely to highlight its importance. In these particular fields, the problem of shortages is not only serious but it is aggravated by the fact that to get people competent to teach or supervise it will be necessary to recruit people already working in these fields, in very short supply, and fully employed. If they are to be recruited, the suggested traineeship program is a must: an absolute minimum.

Mr. Chairman, let me now make a transition from the first phase of the bill to the second by making reference to a matter which would involve both. When we turn to the loan reimbursement provisions of the bill beginning on page 18, we find a proposal designed to attract physicians to rural areas of doctor shortage characterized by low-family incomes. It is to be done by means of an increase in the rate of foregiveness of loans made medical students who subsequently practice in such areas. We certainly have no objections to such a provision though I doubt its efficacy as a persuasive factor in motivating physicians to locate in such areas. If they do, and we shall certainly urge them to, it will be primarily

for far different reasons.

I would point out, however, that it is in precisely such areas of physician shortage that it is most important that we provide a full complement of healthrelated personnel to aid whatever physicians are practicing in such areas. I would point out also that since health-related personnel are frequently women and largely salaried, a bonus forgiveness feature in a loan program would be very meaningful financially to such personnel and could prove a real inducement to serve in such areas. The health-related personnel are, of course, now eligible for student loans just as are other undergraduates. They are not, however, eligible for the forgiveness features offered students of medicine.

I would urge that this committee give very serious consideration to extending to medical technologists and personnel in other allied health professions precisely the same loan forgiveness benefits for serving in shortage areas as are now offered physicians or nurses and as are proposed for physicians and nurses in this bill. You want the physician in the shortage area, of course, but you also want his arms and his legs to be there and that's exactly what health-related personnel represent.

Now, Mr. Chairman, permit me to comment briefly on the loan provisions of the bill.

The administration's higher education bills have been considered by a subcommittee of the House Committee on Education and Labor. Those bills contain provisions similar to those in the bill we are now considering: provisions designed to encourage students to refinance existing loans and to finance future loans through the commercial lending market.

The American Council on Education, which represents over 1,100 colleges and universities and some 231 educational organizations-of which our association is one-testified on the loan provisions of those other bills.

As regards attempts to encourage students to refinance their previous loans, the American Council on Education stated that while it saw no particular disadvan