Senator EAGLETON. Who desires to go next?

STATEMENT OF CHARLES E. BERRY, A.B., M.Sc. H.A., J.D., ASSOCIATE DEAN, SCHOOL OF NURSING AND ALLIED HEALTH PROFESSIONS, ST. LOUIS UNIVERSITY

Dr. BERRY. I probably should follow Sister, Senator.

Thank you for inviting me to testify. I am going to address myself to the charge of allied health professionals, and I want to summarize in about 3 minutes the written testimony without, hopefully, deleting any of the contents.

First of all, I think that health careers must be made acceptable. I think medicine must be made more attractive to women, it has been in other countries; and nursing and the allied fields made more attractive to men. Stabilization of our health manpower pool requires an active program to eradicate the popular conception that medicine is for men, and all other areas of health are poorly compensated women's work.

I think one of the problems of the Government-sponsored programs in recruiting servicemen for the health professions is this image, that the allied health services are women's work, and I have been told that by prospective students.

Assuming that the health professions are somewhat different than that of the physician, I think we can make educational opportunities accessible to many more than we do at the present time. It has been indicated today that shortages of competent personnel are most acute in the rural areas or distressed areas. Î feel an aggressive recruitment of students who have grown up in a rural environment should result in an increased percentage of graduates returning to a rural setting. I hold this opinion despite some evidence that physicians tend to remain in urban areas.

To accomplish this, more adequate support in the form of traineeships must be made available. Such traineeships should provide for all costs, including travel, tuition, housing, and maintenance. I think the availability of such aid will be an attractive incentive for service, particularly to youths from rural or distressed areas. I think also their high school counselors must be thoroughly oriented to these programs and the career opportunities existing in the health field. Traineeships must be made available to the high school graduate who wishes to complete 4 or more years at a college or university awarding a baccalaureate degree or higher degree, whose potential is that of educator, administrator, researcher, or highly skilled technologist in one of the emerging health specialties. This is particularly important in areas that do not have a good junior college system.

The rationale for restricting such aid to those already committed to the field is understandable, in other words, traineeships limited to juniors and seniors, but such a policy excludes or eliminates a large number of capable and interested high school graduates who just don't have the funds to get started and consequently drift into other areas of employment. Proper safeguards in the form of screening techniques and grade requirements could be formulated to insure against abuse or waste of Government funds.

Although not accessible to many, we have an adequate number of educational institutions offering baccalaureate programs in the allied health services to meet projected demands for personnel, if these programs were properly coordinated and if resources in terms of space, faculty, and equipment were properly exploited.

Many colleges and universities including St. Louis University, given financial assistance to expand faculty, laboratories, and space, could substantially increase their enrollment.

Thirty-five years ago St. Louis University became the first college or university in the United States to sponsor a school that included a baccalaureate program for nurses and four allied health programs. In 1969, 186 students were enrolled in the five allied health programs offered by the School of Nursing and Allied Health Professions of St. Louis University. This represented a slight increase, 6 percent, from the previous year. A similar increase is anticipated for the coming school year. On the basis of advance registration, we expect a 6-percent increase this coming year.

If justified by an increased demand that could be generated by expanding the traineeship program, an additional 50 students could be accepted with the employment of five full-time faculty members and an increase of 15,000 square feet of laboratory and classroom space. I am speaking about the program for allied health professions, not nursing.

The degree of preparation for each of the identifiable

Senator EAGLETON. Do you have a package figure on that, what that computes out to in dollars?

Dr. BERRY. 'I'm sorry, Senator.

Senator EAGLETON. You said with five teachers and 15,000 square feet. Do you have a ballpark figure on what that would cost?

Dr. BERRY. No, not on the square feet, but the five additional faculty would run us about $60,000.

Senator EAGLETON. $60,000 a year.

Dr. BERRY. And the square footage would depend on whether we leased or used facilities owned by the university.

Senator EAGLETON. But for $60,000 plus a thousand dollars, maybe another $50,000, no more than that

Dr. BERRY. I think it would be more than that.

Senator EAGLETON (continuing). For leased space?

Dr. BERRY. You have to equip it. You have to have laboratory facilities, furniture, and other items required for demonstration purposes. Senator EAGLETON. $60,000, plus the cost of space and equipping it, how many now?

Dr. BERRY. Fifty.

The degree of preparation for each of the identifiable allied health professions varies. The teacher, administrator, researcher, technologist specialist require a baccalaureate level or beyond, and it is in this area that our greatest challenge exists.

In common with medicine and nursing, allied health professionals in the course of their preparation must be exposed to patient contact in actual work situations under supervision of competent faculty. Faculty supervision must be on a personal basis, both in the laboratory and in the care of patients; consequently, the ratio of faculty to stu

dents requires maintenance of a large teaching staff with attendant expense.

This desirable educational experience can best be offered in a university medical center complex whose resources include a medical school, hospitals, and a school of nursing and allied health professions with access to a full range of related disciplines, for example, education, basic sciences, administration, et cetera, but where the administrative structure with its coordinating processes are in existence.

The allied health programs at St. Louis University and in other schools with similar programs would be severely handicapped or perhaps discontinued if assistance in the form of basic improvement grants has not been made available over the past 5 years. I would strongly encourage this committee to support legislation continuing this form of assistance in an amount and with less rigid requirements for annual increase in enrollment.

My last point. As with all programs designed to meet a growing need, there exists the danger of overproliferation. It is true that new and innovative programs should be encouraged, but it is conceivable that we will so fragment our delivery of health care with specialists, that manpower in terms of efficiency and effectiveness will be dissipated. The needs of the public might best be served by exploring the feasibility of preparing

Senator EAGLETON. Would you say there is any risk at this juncture of overproliferation? There may be some duplication, undoubtedly there is. Do you envision at this juncture overproliferation?

Dr. BERRY. I do. I feel, for some of the reasons that have been mentioned during the course of the day, that we can permit to be developed programs that are so highly specialized that we will not be able to adequately use the skills that have been acquired by some of these personnel.

Senator EAGLETON. Well, that ties in, maybe, a little with what Dr. Stoneman said about Colorado; that is, if we make so many premature, sophisticated licensure requirements without knowing where we are going, we pump a few people into one of those sophisticated titles and keep lots out. Is that part of what you are saying?

Dr. BERRY. That's right, and I am further suggesting that we should have some center or mechanism for researching each of these specialties so that they can be developed or evaluated in terms of developing technology and feasibility of application. I think these studies should be delegated to centers which are adequately funded so that we won't have a duplication, or whatever the terminology may be, of programs which do not really contribute substantially to all of our health

services.

Thank you very

much.

Senator EAGLETON. Very good, Doctor. Thank you. (The prepared statement of Dr. Berry follows:)

TESTIMONY BEFORE SENATE HEALTH SUBCOMMITTEE

September 2, 1970

by

Charles E. Berry, A.B., M.Sc.H.A., J.D.
Associate Dean

School of Nursing and Allied Health Professions

Saint Louis University
Saint Louis, Missouri

Scarcity of Personnel

The shortage of all health professionals has been well documented by the Public Health Service and the National Institutes of Health.* The role of the physician and the nurse are recognized by the consumers of health care, but the contribution of the allied health professional whose skills complement those of the physician and the nurse are not as well known. Over one-hundred of these skills can be identified and each makes a definable contribution to the provision of health care. Although the degree of patient contact varies i.e., the medical technologist has minimal patient contact, while the physical therapist works directly with patients yet they have one thing in common: the increasing dependence upon them by physicians for aid in making a diagnosis and/or rendering

treatment.

-

-

The National Commission on Community Health Services, in its report published in 1966, stressed the need to make health services available, accessible and acceptable to all. The same criteria, but in reverse order, can be used to emphasize the problems involved in recruiting young Americans for careers in the health field.

*Public Health Service Publication No. 263, Section 21. Health. Manpower Source Book 21, Allied Health Manpower U.S. Department of Health, Education and Welfare, Public Health Service, National Institutes of Health.

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THE HMWEDSITY OF OUHAN I'D DIS

136

sensitivity, interest, and empathy for the problems in the Nat
and cay that have existed in the educational system of the hea
professons, particularly as far as input and helping to acquire app
prations locally here at the St. Louis University School of Medicine
I feel that without such interests of people such as these that
Nat would succumb to the enemy within, that being physical, m
ta and moral sickness, decay, and death.

As you gentlemen are well informed, even though we boast of
the chest Nation in the world, and even though we boast of
ng the mecca of medical education for our professional society
ations, here in the United States our infant mortality rate is wor
our maternal mortality rate is worse, our children's physical p
formance ate is worse, the incidence of morbidity and mortality
mary diseases is worse than in some other nations of the world.
The United States cannot hope to raise its average level of heal

out acute attention to the least of these, its minority groups, i
poor, as disadvantaged black or white. Nor can this Nation hope
Fase average level of health and medical proficiency while keepin
as nority groups and disadvantaged down in abject poverty, segr
red and substandard housing, discriminatory and substandard ed
cational facilities and opportunities, discriminatory and insufficie
employment opportunities

Were talked one and lond over the past number of years abo
the need for changing the health care delivery system in this countr
and meeting this critical situation, but I submit, gentlemen, that
dicated by the objectives of this hearing of your subcommitte
whatever system is employed, excellent health care delivery cann
be obtained without the education of more and better health profe
Socals. When I use the term "health professionals" I refer to the
tre spectrum of medical and allied medical careers.

The health of this Nation will be raised only by expert activitie
of these health professionals at a grassroot level in our cities and on
rural areas, the suburbs and the ghettos, but, as you are well awar
there is a grave shortage at all levels of the health professionals
iso humbly submit to you gentlemen that the ideal health standard
of this Nation will never be accomplished until there is a firm com
mctment and involvement at all levels of our society, from the Presi
dent and his Cabinet to the Congress and the Senate of the United
States, to the Governors and legislators of our States, the mayon
and official constituency of our cities, the medical professionals in
Our counties, down to the individual consumer on the streets of our

communities

Senator, I need not remind you or the members of the subcommitte
that the health situation in these United States is critical. Nor need I
of all people, attempt to inform you that to gain populace support
and sense of involvement requires intensive publicity and educational
programs to awaken their awareness and sense of involvement and
sense of personal responsibility if any serious objectives on a national
scale are to be obtained. People as a whole are slow to become involved
but I have the greatest confidence that the people of this Nation can

se to the occasion of a critical moment.

irement of people at levels of our society must be obtained
to think of our health professionals in the third