1. Forks, Clallam County; population (1960) 1,156, (1970) 1,314. One GP 2. North Bonneville, Skamania County; pop. (1960) 494, (1970) 452. No Skamania County (pop. 5,741); has only one physician who is 51 yrs. of 3. South Bend, Pacific County; pop. (1960) 1,671, (1970) 1,720. Now has one GP (57 yrs.) and a G.S. (58 yrs.), and a 39-bed general hospital. Needs 2 GPs capable of surgery and visiting specialists from a variety of specialties. Pacific County has a population of 15,308 and the 2 physicians in South 4. Sultan, Snohomish County; pop. (1960) 821, (1970) 1,110. No physician, no hospital. Monroe 7 miles west (pop. 2,694), has 2 physicians and a hospital with 33 acute care beds and 32 long-term care beds. There is no physician or medical facility to the east until far beyond the summit of the Cascade Pass. The area surrounding Sultan has a population of approx. 6,000. A GP is badly needed now. 5. Connell, Franklin County; pop. (1960) 906, (1970) 950. Connell is located 35 miles north of the tri-cities area (Pasco, Kennewick, and Richland) and 20 miles southeast of Othello, fine hospitals at both locations. The disability of the physician practicing in Connell left it doctorless. Connell is is a trade center of over 3,500 people. Excellent clinic building available. I hope this will be of some interest to you. Sincerely, Path Roth Kinney, Director RK:ST 49-726 O 70-5 The CHAIRMAN. Dr. Bergman, I do not believe there should be justified opposition to this bill, but I couldn't be quite as optimistic as you are in saying "I can't conceive of any justified opposition to this bill." Not justified opposition, no. You put in the word "justified," and that is the saving clause. What about the practical matter of there being opposition to this by doctors and dentists who are opposed to the program? Dr. BERGMAN. Well, Senator, I think that the tools of our profession have changed in the last several years. Doctors and dentists are busy these days and are crying for help. We have found particularly in our rural areas, and I am sure you have found certainly in the State of Texas, with doctors and dentists in rural areas, that competition is no longer a matter that is brought up. They are crying for help and if there are any doctors and dentists in these small communities at all, they are working 14, 15, and 16 hours a day and they don't know what to do; they have no time off, for example. That is what I mean, that the profession is in need of help-and your family practice bill is an example that has the support of the medical profession. The training of paramedical personnel, and another thing that you have been vitally interested in, the returning corpsmen, are needed, and here we find the attitude on the part of the practicing community is one of acceptance, wanting to get more and more people out into the field to help. That is why I made that statement. Plus the fact that the bill insures that corps personnel will be sent only where the medical community welcomes them. Chairman YARBOROUGH. I hope that is true, that we will not have the opposition of medical people. Certainly, I can't see opposition from dentists, as scarce as they are. Your reference to Connell in eastern Washington, which is a trade center serving a farming area of over 3,500 people, makes me recall that I grew up in a small town of about 500 people with a surrounding farming community, and our trade area had another 500 to 1,000 people. We had a few medical doctors; and we had one new one that moved in and there was great jealousy among the doctors in having three in a town of 500. Now, of course, they have no doctors there at all, and it would be impossible, practically, to get one to move in. Dr. BERGMAN. I would like to say, Mr. Chairman, the principle in this bill was adopted by the board of trustees of the American Medical Association several months ago. It was not accepted by the house of delegates, I believe, for more technical reasons, but the principle of Public Health Service physicians giving care in areas where there were not physicians is something that is now freely talked about and I think the vast majority of the medical profession would accept it; certainly the physicians in my State are very interested in this sort of thing. The CHAIRMAN. What would be the effect of ending the doctor draft on this program? Do you think the National Health Service Corps would be able to find enough volunteers? Dr. BERGMAN. I believe so, sir. I don't think ending the doctor draft would in any way deter volunteers from coming into the corps. There is a generation of idealistic medical students and dental stu dents who would like the opportunity to serve their country and serve the underprivileged. Currently, there is no organizational framework in which these people can go to work to help today. Just providing money does not do that much good. There is no realistic way now in which they can go in and serve in such communities, and I believe this bill would provide the opportunity to do so. I believe we would be well supplied with volunteers. The CHAIRMAN. There is legislation now pending in Congress to assist in recruiting doctors for rural areas by financing their medical education. Do you think that it would have any relation to this bill? Dr. BERGMAN. Well, I think that is a very interesting bill and Senator Javits referred to it in his statement, but I think we need a variety of programs to help in this problem of distribution of physicians; there is no one answer. This legislation, S. 4106, is but a small step and the legislation you just referred to is another step; however, that is a financing bill, to finance medical education for physicians who serve in rural areas. Personally, I don't know whether that will do the job. Indenture, I don't think, has worked out too well in other countries, but I think, as you stated in your opening statement, this is the time for action now. Certainly such bills are not inconsistent with S. 4106. The whole country is screaming for action in the area of health manpower and we have to try a lot of different things-we have to step out and do something. The administration has just stood still on this. The CHAIRMAN. The other bill is to give additional people, disadvantaged and advantaged individuals, an opportunity to pursue medical training. The problem I see there, though, is the lack of places in the medical schools for students to attend. In my own State 2 years ago in the fall I know there were 1,230 who applied for admission to the medical schools approved by the local medical societies. The authorities of the medical schools found the high educational training and character of those 1,230 sufficient to go to medical schools, yet the schools admitted only 400 students, and there were 900 that were prepared in that State-which has a great shortage of doctors. These students had no place to go to school. Some found spots in out-of-State medical schools and some in other nations. One country, in its entering class, had 600 students from the United States. We talk about how their medical education doesn't compare to ours, but when these people graduate they will be welcomed back home because we don't have enough doctors. I sent out a letter of appeal last week to the deans of every medical school in the United States, begging them to get 10 percent more students this year than they had last year, or more than they planned to admit, and asked them, if they couldn't admit 10 percent, what additional percent they could admit. As of last night, we had not had one reply that admitted one more student. One school had sympathy with us, but had already agreed to increase their enrollment before this by four students; I tried to get them to admit just one more student and they wouldn't agree. As long as this situation exists we won't admit one more medical student; we won't be able to have real health care for the American people, nor better distribution than that we have; we simply won't have adequate care. I will ask the staff if we have received any more letters. They say "No." I will have comments on the floor of the Senate next week about the state of the medical education; if we don't get a favorable response, well, we will be lucky with 100 medical schools letting in one more American this year. Thank you very much for your attitude toward the necessity for this aid to the American people. Dr. BERGMAN. Thank you, Senator Yarborough. The CHAIRMAN. The next witness is Dr. Amos Johnson, Garland, N.C., the past president of the American Academy of General Practice. Dr. Johnson, we welcome you back before the subcommittee. You have made great contributions to medical care in America, toward helping to solve this roadblock to our rapidly expanding population having the health care necessary to meet its needs. We thank you for the leadership you have exercised. More than any other one person in America, I think you are responsible for the progress made to date on the Family Practice Act. We welcome you back here and you may proceed in your own way, Doctor. I might add that I think the people of the country know how much they owe you or they ought to know-for your efforts to get medical care to the farming and rural areas of our land. Thank you for your contribution. STATEMENT OF DR. AMOS N. JOHNSON, PAST PRESIDENT OF THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA; PAST PRESIDENT OF THE AMERICAN ACADEMY OF GENERAL PRACTICE, GARLAND, N.C. Dr. JOHNSON. Thank you, Senator Yarborough. It is good to be here. Mr. Chairman, I am Dr. Amos Johnson. For 37 years I have been a family physician in a rural community of eastern North Carolina. Some 700 people live in our village. I provide primary health care for families which total some 5,000 people. I am the past president of the Medical Society of the State of North Carolina, and past president of the American Academy of General Practice. For 9 years I was a commissioner on the Joint Commission on Accreditation of Hospitals and I am now serving on the Medical Assistance Advisory Council, which is the National Advisory Council to the medicaid program. As an aside about that, I might state that those of you in the Senate mandated that there be this Council, advisory to the medicaid program, but it has been used but little over the year and it has had little opportunity to contribute much to the medicaid program during the last part of medicaid. The CHAIRMAN. Dr. Johnson, how many people are there on that National Advisory Council? Dr. JOHNSON. There are some 20 or thereabouts, and it was an Advisory Council mandated by legislation that set up title XIX, but for the last 2 years this Council has had very, very little opportunity to study or participate in any of the decisions that have been made. The CHAIRMAN. I direct the committee staff to look into this and to have a report for me by Tuesday, September 1. From the problems that medicaid has now, we see how badly it needs advice from people with expertness in the administration of such programs. I regret to hear this has not prevented these problems and I hope to see it remedied within the coming years. The staff will take note to write this up and bring me a memorandum of this. Thank you for calling my attention to that; that is just one of the many contributions you made to better health care in America. After all, we have a number of tax dollars and have to use them efficiently or all of the bills we pass won't help in medical care. Thank you. Dr. JOHNSON. I am privileged to be here today to present testimony in support of Senate bill 4106, titled the "National Health Service Corps Act of 1970." This bill was introduced in the Senate on July 21 jointly by Senators Magnuson and Jackson of Washington and was then cosponsored by Secretaries Cranston, Hughes, Kennedy, Nelson, Randolph, and Williams of New Jersey. Now it has a bipartisan group of 22 cosponsors. Initially, I want to be recorded as being in support of this bill in its entirety. The basic concepts which this act will implement, if approved by the Congress, are fundamental and essential to "shoring up” vital health care needs of a large segment of our country's population. Essential areas of need for health and medical care services and the potential for this "corps" to effect workable patterns for meeting these needs were ably spoken to on the floor of the Senate by the distinguished group of Senators who introduced and cosponsored S. 4106. It would be redundant to repeat these articulate statements of support for this bill. In the few minutes of my testimony I plan to talk to two facets of potential of this bill which may be more obvious to me perhaps than to many others who read the bill. As a result of experience, observations and, hopefully, wisdom gained during 37 years of general or family practice in a remote, rural, poverty-stricken community such as described by those Senators supporting this bill, I lay claim to a unique body of knowledge related to the needs for this legislation. The opportunity which S. 4106 offers for experimentation and development of knowledge and skills in innovative systems for the provision of health and medical care for the whole spectrum of our population, including the remote, the poor, and the underprivileged alone more than justifies the passage of this bill. Senator Magnuson was more than passingly aware of this potential when, in his introductory remarks, he said, "The National Health Service Corps is, frankly, an experimental concept, and one that may lead to many different conclusions about the nature of health care in the future." That the distinguished Senator from Washington had high hopes that the implementation of this "Corps" could be of tremendous importance to our health care effort is also contained in his introductory remarks: At the very worst, by creating the Corps and setting it in operation we will have provided some health care to those who need it most, and we will have demonstrated to the poor that we truly are concerned about improving their condition. And if the Corps should fare better than this-as I hope and believe it will-its creation will have been a major step in meeting the crisis in health care that we face as a Nation today. |