Again, and I refer in the document to problems of licensure restrictions, et cetera. The last that I heard they were doing a fine job out in the rural communities and taking a tremendous load off of physicians.

I would offer to you in reference to one of the questions that you hoped to touch upon in one of the letters that you sent, you alluded to the fact that our medical schools are accepting only approximately 9,000 students, or 9,100, out of an estimated applicant list of in excess of 30,000. If we take those medical school rejects and asses their ability, shall we say, I think you have a built-in pool of approximately 18,000 to 20,000 young people who already have the background in the humanities, and the sciences. This is, to me, anyway, a real source for training physicians' assistants, if you will.

Senator EAGLETON. That leads us into the area of status, doesn't it, though, Doctor, and isn't that a real stumbling block? Take the students who apply to medical school, all have A.B. or B.S. degrees, and they didn't make it, these 18,000. You then get into the status factor of being something less than a physician. Isn't the psychological hangup of being a subprofessional-that word is sometime used and that word "sub" in and of itself is a negative word-how are we going to get around that status factor?

Dr. TWIN. May I refer to a comment made here. In every other field, one can go from a bachelor's to a master's to a doctoral degree. I sug gest that after 2 years they be given a master's degree or an equivalent to that, and allowed the same vertical mobility that we talk about in the other professional areas. I don't think anybody wants to be an assistant anything all of his life. The intent is not to deadend or pigeonhole nurses, technicians, technologists, and I would answer the tion the same way. This may be a little different, striking, out of order, perhaps, but they needn't be pigeonholed here.

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Senator EAGLETON. If there is a status factor, and I think there is, we have always had it, going back into other forms of education, in the area of vocational education, this stigma sadly that attached to a youngster who went to a vocational high school vis-a-vis the liberal arts high school, and that stigma is still with us, although we are doing better at destigmatizing it, I guess.

Doesn't the sigma or status question make it all the more imperative that there be a close interrelationship with the prestige institution. Let's face it, the prestige institution is the medical school, not derogating a junior college or other institutions, the prestige is with the medical school, and hence would we ameliorate the status factor the closer we keep education related to the medical school, hence give an incentive to the paramedic, the assistant, the subprofessional? Is that in the mix at all, or am I just conjuring something up here?

Dr. TWIN. Are we still talking about the physicians' assistant? Senator EAGLETON. I am talking about the paramedic thing. If the paramedic is to receive the bulk of his education at the junior college level, is he stigmatized maybe in his own mind right from the beginning, whereas if the significant portion of his education is at the prestige institution, the medical school, doesn't that induce him to maybe get into that field of endeavor?

Dr. TWIN. I quite agree that education of health professionals should be conducted in the same atmosphere, in the same educational setting. I would reiterate what Dr. Noback said earlier, that students who learn

together, though they may be in different fields, work together better once they have completed their educational process in on-the-job training. I think this is what you were asking me.

Senator EAGLETON. Yes.

Dr. TWIN. Yes; they should share these experiences, clinical experi

ences.

Senator EAGLETON. Gentlemen, thank you very, very much. Judge and Mr. Mauro.

Judge CURRY. Thank you, Senator.

Senator EAGLETON. In the interest of some who have appointments, we are running behind time, I am sorry to say, but we will hear now from our next group of witnesses in the field of osteopathy, and then also take some area physicians, and then we will take a very short, very short break for lunch before we go into the community support group, so people can plan their agendas accordingly.

At this time we will have Dr. Rudolph S. Bremen, Ph. D., president, Kansas City College of Osteopathy; Dr. Morris Thompson, D.O., president, Kirksville College of Osteopathy and Surgery; and Dr. Richard F. Spavins, D.O., dean, medical affairs, Kansas City College of Osteopathy and Surgery.

Dr. BREMEN. May I express to you, Senator, my appreciation for inviting us to appear before your subcommittee.

Senator EAGLETON. Let me say, we do appreciate these gentlemen who are in the field of osteopathy. We are sorry we didn't work you into the panel over in St. Louis. The testimony is equally good whether given on the east or west side of the State, and I am cognizant of the great contribution osteopathy has made to the general rendering of medical services. I believe Missouri is the cradle of osteopathy. But for the availability of osteopathic physicians, the crisis that we are in, in this State, as is true in every State, but now we are speaking of this State, would be even more pressing, so I am fully cognizant, happily cognizant, of the contribution your profession has made.

STATEMENTS OF RUDOLPH S. BREMEN, PH. D., PRESIDENT, KANSAS CITY COLLEGE OF OSTEOPATHY, AND MORRIS THOMPSON, D.O., PRESIDENT, KIRKSVILLE COLLEGE OF OSTEOPATHY AND SURGERY; ACCOMPANIED BY RICHARD 0. SPAVINS, D.O., DEAN, MEDICAL AFFAIRS, KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

Dr. BREMEN. We appreciate your comments, Senator.

I am going to hit the highlights and overlook the data that we have included in my presentation.

The Kansas City College of Osteopathy and Surgery was founded on May 19, 1916, as a nonprofit corporation under the laws of the State of Missouri. From 1916 through 1970, the doctor of osteopathy degree was awarded to 2,856 graduates. The college is presently the largest private medical college in the State of Missouri, with a first-year class enrollment of 118 students and with a fourth-year class of 113 students. You will note the projections on page 1, which I will pass.

The primary objective of the college is the development of the potentialities of men and women to become highly qualified family physi

cians and to serve society with excellence in health care. The data that I have included on page 2 will attest to the attainment of our objective. whereby in 1969 we graduated 107 physicians, 25 physicians entered residencies, 82 physicians entered family medicine. The percentage for that year of physicians entering family medicine was 76.6.

In 1980 the college will graduate 182 physicians. Eighty percent, or 146 physicians, will enter family medicine, and 20 percent, or 36 physicians, will enter the specialty areas.

I have included, on page 3, the paramedical programs presently of fered by the college, and I won't go over that.

We have developed and are in the process of implementing a health care delivery system which I believe will assist the Greatest Kansas City area, at least our area in the part of Greater Kansas City, to provide more physician manpower to the people. We will assume occupancy in September of 1971 of an acute care center which will be served by satellite hospitals and outpatient clinics located in areas in need of immediate patient care. College physicians and fourth-year students will provide the physician manpower to these satellite hospitals and outpatient clinics. A helicopter service to provide immediate emergency care and rapid transportation to the acute care center for highway, farm, construction, and industrial accident victims will be in operation in the fall of 1971 and the spring of 1972. The helicopters will be equipped with the necessary medical and life-support equip ment to render care at the scene of the accident and during the flight to the acute care center. The helicopter will also accommodate a specially trained physician and assistant. The college will work cooperatively with the police departments, fire deparmtents, civil defense units, and other agencies requiring emergency physician manpower. We have had several discussions with the Police Department of Kansas City, Mo., already.

The satellite outpatient clinics will be staffed by college physicians and fourth-year students who will provide the first level of health care and make house calls, which is a rarity at the present time. They will screen the patients and determine the level of care that should be rendered. It may be either at their home, at the outpatient clinic, or they may be referred to the satellite hospital or the acute-care center. You may note that the acute-care center presently under construction accommodates single-occupancy rooms only. The cost of that center approximates $28 million. Patients housed in the acute-care center who are on their way to recovery and in need of less attention will be transferred to the 150-bed extended-care unit on site, which will be located adjacent to the center.

I have several recommendations to your committee.

One, to establish a national health care delivery ssytem that will provide every person in this Nation the right, not the privilege, to quality health care, because I believe that every person, whether they live in rural, suburban, or ghetto areas, has the right to a high level of health care and we must as medical centers assume that responsibility.

Two, we must also provide full scholarships and loans to students who pledge to enter family medicine.

Three, we must assure Federal funding of basic science facilities to colleges and schools of medicine who are committed to graduate family physicians.

Four, we must also provide Federal financial assistance to the four private schools of medicine located in the State of Missouri: The Kansas City College of Osteopathy and Surgery, the Kirksville College of Osteopathy and Surgery, the St. Louis University School of Medicine, and the Washington University School of Medicine. The State of Missouri should also recognize that these four schools are providing not only physician manpower but health care to the people of Missouri.

Senator EAGLETON. Doctor, how many schools of osteopathy are there in the United States? There are two located here in Missouri.

Dr. BREMEN. Six, and one that has opened in Texas, which makes

seven.

Senator EAGLETON. Where are the other four?

Dr. BREMEN. In Philadelphia, Des Moines, Iowa, Chicago, and Pontiac, Mich.

Senator EAGLETON. Are they of comparable size in terms of student enrollment to the Kansas City school and the Kirksville school?

Dr. BREMEN. Yes, except for the Detroit school, which just opened, and the Texas school, which just opened.

I would like to urge the hospitals and medical centers to limit the duplication of costly medical equipment and procedures. I believe this to be one of the primary results of high health care cost.

We should establish an incentive program in the form of full scholarship to any student who would commit himself to locate for, at least, 2 years in a community in need of a family physician.

I have made comments on your questions in your letter. On the comments of Senator Ribicoff, I will pass over that.

Senator EAGLETON. I think we can put those in the record, Doctor; in fact, your whole statement, of course, will be in the record.

Dr. BREMEN. Very well. I will go to the conclusion.

We at the Kansas City College of Osteopathy and Surgery are in need of a basic science facility, because we believe that with appropriate funding by 1975 we can accommodate 175 first-year students, and by 1977, 250 students. If this is accomplished, 80 percent, or 182 physicians, will enter family medicine. I, for one, do not believe that compression of a curriculum will provide more physicians. Increase in enrollment is the only solution with appropriate funding from the State and Federal Government.

The problem we have at the present time is that we could compress not the time to study but the calendar years into 3 academic years. The tuition is currently at $2,000 per year, and 60 percent of our students are married and must support families. Therefore we must allow them time to work during the summers between academic years to pay for their tuition and meet their financial obligation to the institution and also to support their family.

So I would recommend to you, Senator, higher levels of appropriations to students in the health professions to meet their financial obligations.

I will conclude my remarks and turn it over to Dr. Thompson. (The prepared statement of Dr. Bremen follows:)

52-314 0-71-24

KANSAS CITY COLLEGE OF OSTEOPATHY AND SURGERY

2105 Independence Avenue

Kansas City, Missouri, 64124

Statement presented to the Senate Health Subcommittee at a hearing held on Friday, September

4, 1971, Dental School, University of Missouri at Kansas City.

Submitted by Rudolph S. Bremen, Ph.D., President, Kansas City College of Osteopathy and Surger

INTRODUCTION

The Kansas City College of Osteopathy and Surgery was founded on May 19, 1916, as a nonprofit corporation under the laws of the State of Missouri. From 1916 through 1970, the Doctor of Osteopathy Degree was awarded to 2,856 graduates. The College is presently the largest private medical college in the State of Missouri with a first-year class enrollment of 118 students and with a fourth-year class of 113 students. The 1964-1980 enrollment projections indicated below will attest to the contribution of physician manpower made by the College.