extended through fiscal year 1976. The fiscal year 1971 authorization would be increased from $35 million to $45 million. The authorization for fiscal year 1972 would be $55 million with increases of $5 million for each of the next 4 fiscal years. The student loan maximum would be increased from $2,500 to $3,500 per year for all students. Estimates given to me by medical schools in California are that present student costs average about $6,000 per year and are expected to increase substantially over the next several years. The combination of a loan-the maximum for which the bill would increase to $3.500– and a scholarship-up to $2,500 authorized under present lawwould, therefore, just about cover average costs at these schools right now. However, there are many schools where costs are higher than $6,000 per year, and that figure does not include the added expenses for married students with dependents.

For those who are educationally or economically disadvantaged due to socioeconomic factors, S. 4296 would increase the maximum loan to $7,000 per year. A recent report to the Inter-Association Committee on Expanding Educational Opportunities in Medicine for Black and Other Minority Students, by a task force of the American Association of Medical Colleges, concluded that "the main barrier today for minority students is the inadequacy of financial aid. Coincident with increasing enrollment of minority students in medical schools, Federal Government and other sources of funds have been decreasing. The need is urgent for reversing this trend and establishing a better mechanism for utilizing available funds."

Another feature of the bill is a broadening of present loan forgiveness provisions. Under existing law, indebtedness on health professions loans is forgiven at the rate of only 15 percent for each year of practice in a rural poverty area. S. 4296 recognizes the need to provide greater encouragement for health professionals to practice in areas where the need is greatest, including both urban and rural poverty areas. Under the bill, loans would be forgiven, up to the full amount of the loan plus accrued interest, at the rate of 33% percent for each year in which a physician, dentist, or optometrist practices in either an urban or rural poverty area. This provision for total loan obligation cancellation over 3 years would make cancellation for the first time an attractive alternative to private practice as a means of paying off a student loan. It would also dovetail nicely with Senator Magnuson's proposed pilot project National Health Service Corps, contained in S. 4106, which I am privileged to cosponsor, and which is the principal subject of these hearings today.

In addition, in order to provide a greater inducement for medical and other health professions schools to admit larger numbers of disadvantaged students, S. 4296 would revise the scholarship formula to provide substantial additional assistance to such schools based on the number of such students they enroll. Under present law, this formula is $2,000 times 10 percent of the full-time student population; that is, the school's scholarship fund receives $200 for each student enrolled. The bill would authorize an additional $2,500 to the scholarship fund based on each full-time student who is disadvantaged-as defined in the outreach program which I will discuss next. The bill would also increase the maximum individual scholarship for such disadvantaged students from $2,500 to $5,000, and the scholarship program would be extended through fiscal year 1976.

Finally, S. 4296 would add a new part H to title VII of the Public Health Service Act to provide for grants and contracts to schools and other public or nonprofit organizations for the purpose of identifying, encouraging, and assisting disadvantaged individuals with a potential for education or training in the health professions. Specifically included would be those returning veterans with training or experience in the health field. Individuals would be assisted in enrolling, or in qualifying to enroll, in postsecondary education or training, including health professions schools. The outreach program would also provide for broad dissemination of information on sources of financial aid available for such postgraduate or postsecondary education and training.

To this extent, the bill's outreach provisions are similar to those contained in your bill, Mr. Chairman, S. 3586, the Health Training Improvement Act of 1970 already passed by the Senate (sec. 205), as well as the version passed by the House regarding allied health professionals. However, S. 4296 goes further and specifically would authorize the Secretary to fund such other programs as he determines would enhance the enrollment, pursuit, and completion of study by such disadvantaged persons once they are enrolled in medical and other health professions schools.

The bill would authorize appropriations of $5 million for fiscal year 1971, and $40 million over the next 4 fiscal years for this outreach and special assistance program.

This outreach concept was recommended in the AAMC report on expanding minority student opportunities in the health professions, which I referred to earlier. The report called for a network of regional centers to provide information about career opportunities for disadvantaged students in the health professions. Such a program, the report stated, would serve a vital motivational purpose in encouraging and assisting qualified disadvantaged students who were pursuing or considering education and training in the health professions. The fact is that many, many disadvantaged persons who could be effectively educated and trained for vital health professional roles never consider this as a viable possibility. This program would seek to change that and make clear the great possibilities which exist for them in this highly critical skill-shortage area.

This new outreach initiative would respond to two of the three major needs identified in the AAMC report: (1) recruitment of students into health professions education; and (2) retention of students already in the "educational pathway" leading to such professions.

Mr. Chairman, I wish to point out that physicians' assistants would be assisted under the allied health professions programs contained in S. 3586 now pending in conference committee. Physicians' assistants are specifically recognized in the Senate report on that bill as being one of several new and promising categories of health manpower. Thus, they would not be included under this bill which deals only with the more traditional categories of health professionals. However, I strongly believe that the physicians' assistant is a very important new category in the health manpower area, and must be assisted to the maximum possible extent.

As a member of the Labor and Public Welfare Committee's Health Subcommittee, and as chairman of its Veterans' Affairs Subcommittee, I have attempted to involve myself deeply in the committee's efforts to improve our health care delivery system and to expand our supply of health professionals. Meeting these goals requires increasing our commitment to, and our financing of, student assistance programs, institutional and special project grants to medical and health professions schools, construction funds, and research. However, in expanding and improving these programs I believe we must give special attention to ways in which they can be utilized to improve educational opportunities for the disadvantaged and to improve health care in our poverty areas.

Although I have emphasized the benefits of S. 4296 to disadvantaged health professions students, I would like to make very clear that this bill is also intended to provide general assistance to health professions schools and students by improving and enlarging the loan and scholarship funds available for all students at all medical and health professions schools. We took a major step in this direction by authorizing the appropriation of $100 million in emergency relief for medical and dental schools in financial distress in passing S. 3586. Under the Senate version of that bill the Secretary would be authorized to make grants to medical and dental schools in dire financial straits as a result of their affirmative response to one or more of the following aspects of national health policy: (1) Increasing enrollment of students for the purpose of augmenting the supply of trained health professions personnel; (2) improving the quality or delivery of health care and services to disadvantaged persons in urban or rural areas; (3) providing care to substantial numbers of patients under medicare or medicaid; or (4) maintaining enrollments and quality in the face of rapidly rising costs.

An example of efforts to meet the health professions crisis is the action being taken by the University of California School of Medicine at Davis, where the first-year enrollment of medical students is to be increased from 52 to 100 next year. This 3-year-old school will apply for a 5-year, $5 million grant under the physician augmentation program, which provides grants to medical schools willing to make major increases in their first-year enrollments. According to C. J. Tupper, dean of the school, "The plan reflects the concern on the part of administrative and faculty members as to the school's responsibility in meeting the physician manpower shortage crisis."

The Davis Medical School proposal is an ambitious one. In light of the very pressing needs and the long period of years before an entering medical student actually becomes an M.D., the timing is important and highly commendable. However, much of the success of the expansion will rest on the adequacy of Federal support in such areas as student assistance, institutional support and health facilities construction grants. It is important, therefore, that these vital programs of support for health professions education be maintained and expanded this year and in the coming years, as proposed in S. 4296, if initiatives like those proposed by University of California at Davis are to succeed in helping to solve the health manpower crisis.

Mr. Chairman, I request that there be included in the hearing record, following my statement, an analysis of the bill. I thank you for including S. 4296 for consideration at this hearing and for your courtesy in

permitting me to submit this statement. I especially want to thank you for the leadership and inspiration you have provided to me and the other members of the Labor and Public Welfare Committee in dealing with the critical health problems confronting the Nation.

ANALYSIS OF S. 4296, THE PROPOSED "HEALTH PROFESSIONS ASSISTANCE AMENDMENTS OF 1970."

I. GENERAL DESCRIPTION

The bill is designed to encourage and assist persons who are financially or educationally disadvantaged because of socio-economic factors to pursue training in the health professions. It would accomplish this by establishing a special outreach program to identify, encourage, and prepare disadvantaged persons to enroll in health profession schools and making grants to those schools once they enroll significant numbers of disadvantaged students. In addition, the present law concerning loans and scholarships for students in the health professions schools would be amended (1) to extend these two programs through fiscal year 1976; (2) to raise the maximum limits on loans for all students and on scholarships for disadvantaged persons; (3) to increase the authorizations of appropriations for the loan program; (4) to provide for substantial increases in the allocation of scholarship funds to schools in direct proportion to the number of disadvantaged students enrolled; and (5) to provide increased incentives for practice in urban or rural poverty areas by providing for full cancellation of student loans in return for three years of practice in those areas.

II. SHORT TITLE

Section 1 gives the Act the short title "Health Professions Assistance Amendments of 1970."

III. HEALTH PROFESSIONS OUTREACH PROGRAM

Section 2 of the bill would add a new Part H to Title VII of the Public Health Service Act. Title VII now includes provisions concerning training of professional health personnel. Part H would establish a new program to identify, encourage, and assist disadvantaged persons to prepare for, enter and complete training in the health professions. Part H consists of one section, 799a. It is analyzed by its three subsections. With the exception of clause (3), which is new, it is similar to the outreach provision contained in section 205 of S. 3586, the proposed "Health Training Improvement Act of 1970," passed by the Senate on July 13, 1970.

Subsection (a) of Sec. 799a. Clause (1) gives grant and contract authority to the Secretary of H.E.W. to establish, through public and private educational or other agencies, programs to identify potential health professions students who, due to socio-economic factors, are financially or educationally disadvantaged (Veterans with training or experience in the health field are specifically included.) Such individuals would be encouraged and assisted to enroll if qualified, or to undertake such post-secondary work as is necessary to become qualified to enroll, in a health professions school.

Clause (2) specifies that a school's or organization's encouragement and assistance efforts would include publicizing existing sources of financial aid available to persons who are enrolled in health professions schools or are undertaking training necessary to qualify for enrollment in any such school.

Clause (3) of this subsection would provide for grants to or contracts with schools to establish programs which the Secretary determines will enhance and facilitate enrollment, pursuit, and completion of study by disadvantaged persons who are potential health professionals.

Subsection (b) of Sec. 799a. Defines "professional personnel in the health professions" as doctors of medicine, dentistry, osteopathy, pharmacy, (or bachelor of science in pharmacy), optometry, podiatry or surgical chiropody, veterinary medicine or graduates of schools of public health. This definition is consistent with other parts of Title VII concerning types of health professions schools to which grants are made for construction, student loans and scholarships.

Subsection (c) of Sec. 799a. Would authorize appropriations for Part H from fiscal years 1971 through 1975. The initial authorization is $5,000,000 for FY 1971, and the authorization for each subsequent year is increased by $2,000,000 a year.

IV. STUDENT LOANS

Section 3 of the bill would amend the health professions student loan provisions of Title VII of the Public Health Service Act, 42 U.S.C. 294 a-b.

Loan Levels. Clauses (1) and (2) of subsection 3 (a) would increase the pres ent maximum loan level for all students from $2,500 to $3,500 per academie year.

Clause (3) would establish a maximum loan level of $7,000 for disadvantaged students described in the Outreach Provision (Part H of section 799a).

Cancellation of Loans. Subsection 3(b) of the bill would amend present law which cancels student loan indebtedness incurred by physicians, dentists, and optometrists at the rate of 15 percent for each year of practice in a rural poverty area. The annual rate of cancellation would be raised to 33% percent, and the qualifying geographical areas would be expanded to include urban as well as rural poverty areas. The present provision permitting an additional 50 percent cancellation of the debt for work in a rural area is rephrased for clarity.

Student Loan Authorization. Clause (1) of Subsection 3(c) would amend the present student loan authorization section which now expires with an authorization of $35,000,000 in fiscal year 1971. The new schedule would begin with a fiscal year 1971 authorization of $45,000,000, rising to $55,000,000 for 1972, and increasing by $5,000,000 each fiscal year thereafter through fiscal 1976.

Clause (2) of subsection 2 (c) would advance the dates but retain the present scheme for phasing out the student loan authorizations. For the three fiscal years following the last specific year's authorization, such sums would be authorized to be appropriated as are necessary to continue to provide loans to students who began their health profession training with a loan under this program.

V. SCHOLARSHIP GRANTS

Section 4 of the bill would (1) amend the present formula for scholarship grants, (2) extend the scholarship grant program through fiscal year 1976, and (3) raise from $2,500 to $5,000 the maximum limit on scholarships in the case of disadvantaged students described in the Outstretch Program (Part H of section 799a).

Scholarship Grant Formula. Subsection 4(a) of the bill would change the formula for scholarship grants to schools. The present formula provides a sum equal to $2,000 multiplied by one-tenth of the enrollment, that is, $200 for the scholarship fund based on each student enrolled. This provision would add to the scholarship fund $2,500 based on each disadvantaged student enrolled. It also would extend the scholarship program beyond fiscal year 1971, the last year authorized in present law, to fiscal year 1976.

Scholarship Grant Authorization. Subsection 4(b) and clauses (1) and (2) of Subsection 4(c) provide, comparably to the provisions in section 3(c) (2) of the bill regarding the loan program, for extension of the dates of the scholarship program and for a gradual phasing out of the grants to ensure that a student who began his training with a scholarship may be assisted through to completion. Scholarship Limit Raised. Clause (3) of Subsection 4(c) would increase the maximum scholarship which can be awarded during a school year from $2,500 to $5,000 in the case of disadvantaged students.

The CHAIRMAN. Senator Murphy has introduced S. 4208, the Family Physician Scholarship and Fellowship Act. We will receive his statement for the record.

STATEMENT OF HON. GEORGE MURPHY, U.S. SENATOR FROM THE STATE OF CALIFORNIA

Senator MURPHY. Mr. Chairman, on August 10, I introduced S. 4208, the Family Physician Scholarship and Fellowship Program Act. Nineteen Senators have cosponsored this measure with me. They are Senators Allen, Allott, Bennett, Boggs, Cooper, Cotton, Dole, Dominick, Eastland, Fong, Griffin, Hatfield, Javits, Pearson, Prouty, Saxbe, Smith of Illinois, Thurmond, and Tower.