APPENDIX I TABLE 1.-DISTRIBUTION OF NON-FEDERAL PHYSICIANS AND POPULATION BY COUNTY GROUPS, AS OF DEC. 31, 1965 (BASED ON DATA FROM AMA, "DISTRIBUTION OF PHYSICIANS, HOSPITALS, AND HOSPITAL BEDS IN THE UNITED STATES, 1966'') 1 109 counties in SMSA's with 1,000,000 or more inhabitants. 4 Sum of first three groups. 2301 counties in SMSA's with 50,000 to 1,000,000 inhabitants. 3889 counties contiguous to metropolitan areas. Population in such counties ranges from 500 to 508,500 inhabitants. $1,024 counties containing at least 1 incorporated place with 2,500 or more inhabitants. 758 counties not included in the above 4 groups. 7 Total of isolated semirural and rural. APPENDIX 2 This bill provides for far fewer personnel than could adequately meet the needs of even a few federally-funded health programs. A preliminary survey of manpower requirements that could be met with National Health Service Corps personnel made recently in the Department of Health, Education, and Welfare yielded a figure of two hundred and seventy doctors, and two hundred and eighty other health professionals. These figures apply only to section 314E, Migrant Health, Community Mental Health Centers, and OEO projects. The personnel that could be provided by a National Health Service Corps and utilized by the Office of Child Development (children and youth, and maternity and infant care), model cities projects, public health service hospitals, and the Indian health service have not been calculated. The CHAIRMAN. In your statement, you say: For many years the concept of the National Health Service Corps has received wide support from young professional in medicine. I am wondering why I never heard that before. I have been on the subcommittee nearly 13 years. Dr. SHANNON. Unfortunately, Senator, the young medical students are just beginning to understand power in Washington, and the places and methods to get particular ideas out front. I think our presentation today is an indication of that, and it is only in the last 2 years that we have testified before committees. The CHAIRMAN. You also state: The National Convention of the Student American Medical Association have seen the passage of major resolutions supporting the establishment of such a Corps. Dr. SHANNON, Yes, sir. The CHAIRMAN. Now you might have sent to members of the health subcommittee some copies, and I won't say they were not sent, but they were not received in my office. On a busy day, of course, the mail is sometimes so heavy that we might get 5,000 letters in 1 day, and we do not have enough people to open all of that mail, and without these electric machines I doubt that we would have gotten it open. With that kind of mail, I can't say I didn't get copies, but I don't recall ever receiving them. However, I thank you very much for this contribution. It is very helpful to us. Dr. SHANNON. If you like, Senator, I could send copies of the resolutions to you in bulk form. The CHAIRMAN. I wish you would. I would like to direct the staff to put it in the record here; I want it in the record, not for me personally, but we want to print it here to show the long years of support, how this idea is not something new that just jumped up on the spur of the moment, but something that has been needed for years. Has it been called to the attention of Members of Congress, any of the Members during this time? Dr. SHANNON. Yes; these resolutions have gone out to all Members of Congress, as per a part of the statement in each of the resolutions, the statement that these have to go out to Members of the Congress, and appropriate committees. The CHAIRMAN. Well, I am really surprised I have not seen them, because I get volumes of resolutions from the American Legion when it has a convention, and the VFW, and I thumb through them carefully. Rollcall is going on, and the hearing will be immediately adjourned This closes the oral hearing, but we will keep the record open until September 2, and you can submit written data to that point. It will be included in the written record. We have had very fine presentations today, and I want to thank all of you. These papers show work and were not just thrown together instantaneously, and I hope the country responds. Before closing, I will state to Dr. Nolan the data you furnished with your statement, the supplementary data will be filed for reference, but not printed in the record, because that would hold the record up, but we will file it for reference with the committee so it will be available in debate on the bill just as fully as though it were printed. Also, I order printed all statements of those who could not attend the hearing and all other pertinent material submitted for the record. (The material referred to follows:) Hon. RALPH W. YARBOROUGH, AMERICAN DENTAL ASSOCIATION, Chairman, Committee on Labor and Public Welfare, Washington, D.C. DEAR SENATOR YARBOROUGH: I am writing you in regard to the August 28 hearing held by your Committee on S. 4106, the National Health Service Corps Act of 1970. It is our understanding, based especially on the level of appropriations authorized in the measure, that the National Health Service Corps would essentially constitute an experimental approach-among those others already established or being considered-to facilitate the ready accessibility of health care in, as the bill states, "those communities and areas of the United States where health personnel, facilities and services are inadequate . . ." Priority, the bill also notes, would be "given to those urban and rural areas of the United States where poverty conditions exist." Certainly, it is true that this nation is not yet to the point where continuing. high quality health care of a comprehensive nature is readily available to all citizens. The Association has long recognized that the unequal distribution of dentists is an important factor in this situation. Efforts to remedy this problem unquestionably deserves high priority. The Association, then, is in accord with the general purposes of S. 4106. I should like to call the Committee's attention to one section of the proposal, however, that the Association believes must be amended before enactment into law. This is the Section 399L which establishes the National Health Corps Advisory Council. Though provision is made for fully half the membership to be drawn from the Department of Health, Education and Welfare, no provision is made for any inclusion of members of the private health professions. The Advisory Council's role with respect to establishing utilization guidelines, setting criteria for site selections and in choosing personnel is such that we consider it imperative for representatives from dental private practice to be numbered among its members. Provision is made in the bill for local consultation with "medical, dental and other medical personnel" by the Council, but we believe that representation from private practitioners on the Council itself is necessary. I should like to request, Mr. Chairman, that this letter be made a part of the hearing record on S. 4106. On behalf of the Association, may I convey to you our cordial best wishes and assure you once again of our abiding respect for your distinguished contributions to the improvement of the health of the American people. Sincerely, RICHARD K. MOSBAUGH, D.D.S., WASHINGTON/ALASKA REGIONAL MEDICAL PROGRAM, Hon. WARREN G. MAGNUSON, Old Senate Office Building, Washington, D.C. DEAR SENATOR MAGNUSON: I have read with great interest your bill S. 4106, National Health Service Corps, and write to express my approval. The promptness with which hearings on the bill have been scheduled prevents my obtaining an official response from our Advisory Committe but the bill addresses itself to a desperate health manpower distribution problem which has seriously concerned both our Regional Advisory Committee and the staff of the Washington/Alaska Regional Medical Program. It seems clear that the maldistribution of physicians will be corrected only by a program such as you have proposed since the available evidence indicates that there are no incentives sufficient to direct physicians to the many rural and urban areas of need. I wish it were possible to modify the Selective Service Act to assign a larger number of physicians to such areas of need, but I am told the chances of accomplishing this are out of the question for the near future and since there is real urgency to the problem, your approach seems a logical one. Under the circumstances, your bill will provide a demonstration of value which should allow a subsequent effort of greater magnitudes should it be successful as I am confident it will. I presume the bill may still be modified and have a few suggestions to offer. It will be vital that these young men work under the supervision of experienced clinicians and this relationship needs to be clearly described. Wherever possible, it would be desirable that the young physician also have a clear and meaningful relation to a medical school or teaching center in order that he continue to learn and that the center benefit from his experience. Since RMP's have demonstrated that they can be an effective bridge between teaching centers and the community, I think they could be of real assistance to the National Health Service Corps Program. I think it would be desirable to set up guidelines relative to fees charged for the services provided by the National Health Service Corps men so that the gen eral medical community in which the young men practice will not feel threatened by the possibility of unfair competition. It would be highly desirable that this program have some assurance of continuity and I am sure you have this in mind. In this regard, it should be of interest to note that a significant number of Public Health Service physicians assigned to the Alaska Native Service find their tour of duty sufficiently rewarding that they settle out in Alaska and provide much needed help to that state. I think there is a good likelihood that the same thing would happen with the young men in your National Health Service Corps. While I have made a few suggestions for modifications in your bill, I would like to make it clear that I endorse it as an important step toward meeting one of the most serious and urgent health care needs. Respectfully yours, DONALD R. SPARKMAN, M.D., Director. NATIONAL TUBERCULOSIS AND RESPIRATORY DISEASE ASSOCIATION, Hon. WARREN G. MAGNUSON, Washington, D.C. New York, N.Y., August 11, 1970. DEAR SENATOR MAGNUSON: We have noted that you recently introduced S. 4106 for the purpose of establishing a National Health Service Corps. We are happy to offer our endorsement of this legislation. The availability of physicians to work in local health programs is of particular importance in tuberculosis control; their current scarcity is imposing unfortunate restrictions on outpatient services for patients with this disease. The disallowance under the current Selective Service law of physicians fulfilling their military obligations through assignment to health programs in the states has been most disruptive to the tuberculosis control program in the U.S. Experience in the years when obligated service physicians were detailed by the Public Health Service to work in tuberculosis clinics receiving Federal tuberculosis project grant funds was highly favorable. Reports from areas throughout the country indicated that these young physicians, who were given specific training by the Tuberculosis Program of the Center of Disease Control in Atlanta, Georgia, often greatly increased the productivity of tuberculosis control services and was a way of initiating new services. It is important that tuberculosis patients receive adequate treatment not only for their own condition but to reduce exposure of the healthy population to a communicable disease. Since it is now possible to administer tuberculosis therapy outside of hospitals, this comparatively inexpensive treatment should be carried out to its fullest potential. To let people develop serious disease which requires hospitalization is a waste of resources. As we interpret the bill, it would be possible to utilize commissioned officers and personnel of the National Health Service Corps in outpatient clinics receiving either 314(d) or 314(e) Comprehensive Health Program monies, currently the major source of Federal support for tuberculosis control, or in those receiving OEO funds such as the Neighborhood Health Centers, many of which also include services for tuberculosis patients. We hope that S. 4106 will receive broad support from the public health community. Sincerely yours, ROBERT J. ANDERSON, M.D., Managing Director. AUGUST 28. 1970. Hon. WARREN G. MAGNUSON, Washington, D.C. DEAR SENATOR MAGNUSON: Doctor Don Sparkman, Director of the WashingtonAlaska Regional Medical Program, has asked me to comment upon the National Health Service Corps Act of 1970 (S. 4106) introduced by yourself and Senator Jackson and has suggested that I forward my remarks to you. I hasten to add that all of my remarks are my own personal opinion as a private constituent and physician whose home is the State of Washington and that I can in no way represent or speak for the U.S. Public Health Service or for the Department of Health, Education and Welfare. Nevertheless, it is pertinent for you to realize that I am a Commissioned Officer in the Regular Corps of the U.S. Public Health Service, Medical Director grade (0-6), whose current assignment is Director of the Seattle U.S. Public Health Service Hospital. With that elaborate preamble, I should simply like to say that I have read your bill with a great deal of interest. I believe it represents a very small step in the right direction and that it could lead to an exciting and effective innovation in helping to correct the mal-distribution of physicians and of health services generally in the United States. Our experience here in Seattle with the various free clinics-including the Kinatechatapi Indian Clinic located at the Public Health Service Hospital-provides very convincing evidence of the great need amongst the urban poor, despite all the new programs such as Model Cities and Office of Economic Opportunity which are designed to help alleviate the problem. Virtually every rural community is "under-doctored". We have reached the point, by virtue of Hill-Burton, that we have modern hospital facilities in a number of rural communities, but NO physician to staff them. Some rural community physicians are so over-worked that they move to the city to obtain relief, even though they and their families may prefer to live in a rural setting. Many rural physicians find themselves unable to maintain their skills through continuing education programs because they cannot find a "locum tenens" M.D. to take their busy practices for a week or two per year. Public Health Service physicians now sometimes volunteer as "locums" but they must use their annual leave to do so. I am personally very much persuaded that your bill is the first frontal assault that has been made on these problems, although Hill-Burton, Regional Medical Programs, and Comprehensive Health Planning have all been helpful in one way or another. I sincerely hope S. 4106 is passed by the Congress, and I will pledge whatever personal support someone in my position can properly provide. Sincerely, WILLARD P. JOHNSON, M.D., Medical Director, U.S. Public Health Service. |