Medical education is expensive making it difficult for lower income and minority individuals to enter the medical profession. Great efforts are being made. For example, in my State of California, the University of California has five medical schools in its system. Only eight minority students were enrolled on the five medical school campuses of the University of California system in 1968, and they were all at the San Francisco campus. By 1969, 54 minority students were enrolled, with each of the five campuses showing minority enrollment. By 1970, the number had increased to 93. The percentage of the minority enrollment varied from 13 to 25 percent, which shows that great efforts are being made in this direction. TAPPING THE IDEALISM AND ENERGIES OF YOUTH Mr. President, we know that many young people today are filled with idealism and have a strong commitment to help make this country a better place in which to live. I have talked to some of the medical students and found that there is a great interest and desire among them to serve the disadvantaged to meet the medical needs of the citizens of this country. Their commitment to service is great indeed, and they seem willing to forgo some of the more lucrative locations in order to have an opportunity to serve. My measure would provide a means to channel their talents, energies and idealism into the communities of the country which are crying for medical attention. My measure is designed to train more doctors and to direct these doctors into the right places. CONCLUSIONS Mr. President, the Scripps-Howard newspapers recently concluded a monthlong survey of doctors, both in private practice and working in government. Mr. Donald Kirkman writing in the July 7, 1970, Washington Daily News said: "With surprising unanimity, those interviewed agreed that: The U.S. needs an immediate crash program to increase the number of health workers, with primary emphasis on doctors; "Doctors in the U.S. are over-concentrated in suburbia and most have little desire to practice in ghetto and rural areas; "Many of the nation's medical colleges and other health education institutions are on the verge of bankruptcy; "Medical education is so costly that Negroes, the children of other minority groups, and poor whites are prevented from becoming doctors and dentists; "The number of Negro and minority doctors is not keeping pace with the increase in the nation's Negro and minority population." I believe, Mr. President, that my measure responds to most of the needs which the survey indicates are recognized by the doctors themselves. As a member of the Senate Labor and Public Welfare Subcommittee on Health, I have supported and helped to shape the various programs that have been enacted to advance medical research, to provide the medical manpower necessary to do the job. Only recently I supported the Health Training and Improvement Act, a bill to extend and improve the allied health professions program which was initially enacted in 1966. Recent years have seen a quantum leap in the demand for health services. This is as it should be as the nation moves to provide quality medical care and treatment for all its citizens. Although the medical care in this country is the finest in the world, our medical system does have serious problems. One of the most serious problems, which has already reached the crisis stage in many areas of the Nation, is the medical manpower shortage. The demand for more and better medical care and services is likely to continue to accelerate. A serious obstacle to meeting that growing demand is, and will be, unless steps are taken, this medical manpower shortage. Dr. Egeberg emphasized this point when he said: "I don't care what Congress does with medicare, medicaid and all the other programs. Nothing is going to improve the country's medical system until we get more doctors. Mr. President, no one can say for certain that a new proposal, such as I advance today, will prove one hundred percent successful. Based on the evidence and surveys available, as well as common sense. I believe the program will work. It will help with the family physician shortage problem: it will help to redirect physicians to serious physician-shortage areas; and it will provide greater opportunity for lower income and minority students to enter the medical profession. I discussed this proposal with the California Medical Association, and I am very encouraged with their reaction, encouragement and support. Mr. President, I am also delighted with the encouragement I have received from deans of medical schools in California. I sincerely hope that the medical community, the administration and my congressional colleagues study this measure and join me in working for its enactment. The CHAIRMAN. Now we come to the professional witnesses, and the first witness is Dr. Abraham Bergman, director of outpatient services of the Children's Orthopedic Hospital, Seattle, Wash., representing the Washington/Alaska regional medical program, and the Washington State Society of Pediatrics. STATEMENT OF DR. ABRAHAM B. BERGMAN, DIRECTOR OF OUTPATIENT SERVICES, CHILDREN'S ORTHOPEDIC HOSPITAL, SEATTLE, WASH., REPRESENTING WASHINGTON/ALASKA REGIONAL MEDICAL PROGRAM, WASHINGTON STATE SOCIETY OF PEDIATRICS Dr. BERGMAN. Mr. Chairman, I am Abraham B. Bergman, a physician specializing in the care of children. I am director of outpatient services at Children's Orthopedic Hospital and Medical Center in Seattle and associate professor of pediatrics and health services at the University of Washington in Seattle. I am legislative chairman of the Washington State Society of Pediatrics, and am also representing the Washington/Alaska regional medical program, serving the largest geographic area of any RMP program in the country. I first wish to pay tribute to the distinguished chairman of this committee, Senator Yarborough, whose name is firmly linked with virtually all programs in the past decade launched to improve the health of the American people. It is a record of which you can be justly proud, and for which all health organizations in the country owe you a deep debt of gratitude. COMMUNITIES THAT NEED PHYSICIANS Wrangel is an isolated village in southwestern Alaska with a population of just under 3,000 persons. A year ago its only physician left, and the community has since been without any medical services. Darrington is a town of 1,000 persons nestled in the North Cascade Mountains of Washington that has been attempting for 5 years to recruit a physician, to no avail. Connell is in eastern Washington and is a trade center serving a farming area of over 3,500 people with a fine federally funded hospital nearby. Its one physician is now disabled, and can see no more patients. In the large city of Seattle there are many physicians, but they are concentrated in the more affluent areas. On the other hand, there are several large publicly financed housing projects with completely inadequate health services, where residents have only an emergency room of the county hospital to turn to for medical care. I could cite many more examples, but they would be repetitious and glaringly familiar to all Members of Congress. I am sure that a significant amount of mail to your offices concerns in some way the distribution of health services, describing examples of the type I have just cited. They exist in every single State of the Union. I would like to submit, for the record, a letter outlining statistically the dimensions of the maldistribution problem in a typical State, Washington. The National Health Service Corps will not solve the physician distribution problem. It is but a small step in meeting a few of the most extreme cases of hardship among our rural and urban poor. More important than the number of Health Corps personnel that would be deployed in this pilot program would be the commitment to take some action toward solving this vexing national problem. One can't pick up a magazine these days without seeing an article about the health manpower crisis. Bold innovative action is required; rhetoric and handwringing will not do the job. ADVANTAGES OF HEALTH CORPS I would like to comment on several features of S. 4106 that I find particularly attractive: LOCAL INITIATIVE Health Corps members will be assigned only upon application from, and certification of need by, local communities. Competition with local health resources is not an issue in this bill. We are addressing ourselves to communities where local physicians and dentists, if they exist at all, are pleading for help. REJUVENATION OF THE COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE Rather than starting yet another Federal agency with its own bureaucracy, this bill proposes to provide the Commissioned Corps with a new mission befitting its long and proud tradition. The fate of the corps has been held in limbo by procrastination and indecision on the part of the present and previous administrations for too long. The should not be allowed to wither on the vine. corps INCREASED UTILIZATION OF PUBLIC FUNDED FACILITIES A variety of publicly funded health programs in rural and urban poverty areas are operating at reduced and inefficient capacity because of difficulties in recruiting and paying personnel. Examples are neighborhood health centers, large municipal hospitals, institutions for the mentally ill and retarded, migrant and Indian health programs, and many others. Under this bill, National Health Service Corps personnel could be assigned to such programs, to help to get them off the ground and to operate more effectively in performing the missions already assigned them. CHANNELING IDEALISM OF YOUNG HEALTH PROFESSIONALS Our current crop of health science students appears to profess a great deal more concern about improving community health than previous generations. Personally, I am reserving judgment on the ex tent to which this idealistic talk will be translated into deeds. Nevertheless, appropriate opportunities for helping the underprivileged should be made available. The fact that health professionals can only join the corps through volunteering, and that their assignment will be to "nonplush" living areas, provides an ideal channel for service to the Nation, and an opportunity to serve in areas where such service is now impossible. In conclusion, I can't conceive of any justified opposition to this bill. I am delighted that Surgeon General Steinfeld endorsed it as "excellent" during testimony several weeks ago on the HEW appropriations bill. I applaud you Senator Yarborough, on your leadership on this legislation, and urge you to take rapid and favorable action. (The information referred to follows:) The Washington State MEDICAL EDUCATION and RESEARCH FOUNDATION 444 N. E. Ravenna Boulevard August 25, 1970 Telephone (206) LA 3-9110 Abraham B. Bergman, M.D. 4800 Sand Point Way N.E. Seattle, Washington 98105 Dear Doctor Bergman: The State of Washington presently has 5,390 physicians licensed to practice and who have addresses in this State. Thus, the State of Washington has one physician for every 619 persons, or 161 physicians per 100,000 population. This ratio is rather meaningless, though, because neither the population nor the physicians are spread evenly over the State and only about 4,700 physicians are actually engaged in patien care; most of them are in the heavily populated counties. Nearly two-thirds (62.4%) of the State's population live in the four most populous counties--King, Pierce, Snohomish, and Spokane--which comprise only 11% of the land area but have 78% of the physicians. King County alone has one-third (34%) of the population, 3% of the land area, and 52% of the physicians. Furthermore, there is a shift in the population from the rural to the suburban and urban areas. From 196 to 1970, 40% of the population increase was in King County and 80% in the four mos populous counties mentioned above. Two western rural counties and twelve eastern rural counties have shown a decrease in population from 1960 to 1970. My latest count is that there are 76 locations within the State looking for physicians nearly all of these are seeking GPs. I would say that the real shortage of physicians in the State is within what I call the first-contact physicians, i.e. GPs, internists, pediatricians, and general surgeons (I realize that general surgeons wouldn't like my categorizing them in this way, however in the rural areas they act much the same as a GP). I figure that there is a shortage of around 936 of these first-contact physician This is on the supposition that to provide a reasonable degree of medical care, we sh allow one first-contact physician per 100,000 population. You didn't give me much time to work at it, but the following are five cities--and th are many more--which are in very desperate need of physicians: an affiliate of the Washington State Medical Association |