my judgment, would be to increase their salaries. Not infrequently, medical librarians are salaried at levels less than a good secretary or a good stenographer in certain parts of the country. The CHAIRMAN. Would they be that low? Dr. WAKERLIN. I think so, in certain areas, sir. There are salaries of $4,800, $5,000, $5,200 a year for some of our medical librarians. I saw a figure recently-I don't know how accurate it is and I hope it is untrue that the top medical librarian salary in the country, and this was a few years ago, was $14,500. If we want to attract physicians into medical librarian opportunities, we are going to have to pay better salaries than that. We certainly could use these special fellowships that are indicated in S. 597, and surely, there is need for improving and expanding the basic resources and operational facilities of libraries. There is surely a great need for more research in library methodology and this bill would provide for support of such research. And Dr. Chapman referred, of course, to the importance of subsidizing certain scientific publications which are not commercially profitable but, which are very important from the standpoint of advancing medicine and science. Lastly, I should say again, as he did, that regionalization of library facilities and opportunities is a very important provision of this bill and would have an effect, certainly, in improving the library facilities of our community hospitals in the smaller towns and cities over the country. In other words, if this bill were to pass, and I personally, and the American Heart Association as an organization, very much hope that it will, this bill indirectly will improve medical research, it will improve professional education and thereby patient care, health education of the public, and also community health programing. I think the need of the libraries of medicine is great. The benefits from this bill, if it is enacted into law, will be very important to our people. Federal leadership is very much necessary here, Federal subsidization is very much necessary, and the American Heart Association, sir, is heartily in support of S. 597 and the companion bill in the House. The CHAIRMAN. The truth is, in a way, this is a necessary complement to what the Federal Government has done in medical research, is that not true? Medical research is wonderful and we have done a lot with it, but it does not do any good to find the knowledge unless you get it in the hands of those who need it, is that right? Dr. WAKERLIN. This is indeed correct, sir. I saw a figure recently that the National Institutes of Health, which of course support research in large amounts, approximately $1 billion a year, are in the position at the present time to support libraries to the extent of about $1 million a year, or about one-tenth of one percent, which is therefore definitely smaller than the figure of 1.5 percent which Dr. Chapman quoted for medical schools. I think one measure of a university is how it treats its libraries. On that basis, there are some universities that do not come cut too well, Mr. Chairman. The CHAIRMAN. Anything you would like to add, Doctor? The CHAIRMAN. You brought us some fine testimony. We deeply appreciate it and certainly want to thank you both. Thank you. Now, Dr. William A. Sodeman, dean of the Jefferson Medical College and member of the American Medical Association Council on Medical Education. STATEMENT OF DR. WILLIAM A. SODEMAN, DEAN OF THE JEFFERSON MEDICAL COLLEGE, AND MEMBER OF THE AMERICAN MEDICAL ASSOCIATION COUNCIL ON MEDICAL EDUCATION, ACCOMPANIED BY DR. C. H. WILLIAM RUHE, ASSOCIATE SECRETARY OF THE AMA COUNCIL ON MEDICAL EDUCATION; AND PAUL R. M. DONELAN, ATTORNEY ON STAFF OF THE AMA LEGISLATIVE DEPARTMENT Dr. SODEMAN. Thank you, Mr. Chairman. As you have mentioned, I am Dr. William A. Sodeman, a physician residing in Philadelphia, Pa. I am dean of the Jefferson Medical College of Philadelphia and serve as a member of the American Medical Association Council on Medical Education. With me today are Dr. C. H. William Ruhe, associate secretary of the AMA Council on Medical Education, and Mr. Paul R. M. Donelan, an attorney on the staff of the AMA legislative department. The CHAIRMAN. May I say we are happy to have Dr. Ruhe and Mr. Donelan with us, too? Dr. SODEMAN. Thank you very much. The American Medical Association has always recognized the importance of medical libraries at all levels of education for health personnel. Evidence of this is contained in statements of the "essentials" of various educational programs accredited by the AMA Council on Medical Education. For example, the following paragraph is contained in "Functions and Structure of a Modern Medical School," a statement developed by the American Medical Association and the Association of American Medical Colleges as a general guide in the medical school accreditation program: A well-maintained and cataloged medical library that can be used conveniently and effectively by both students and faculty is essential to a modern medical school. A trained librarian with experience in medical library work should be employed to supervise the development and operation of the library with the advice and assistance of an active representative committee of the faculty. The library should receive regularly the leading medical periodicals, the current numbers of which should be readily accessible. Adequate arrangements should be made by the librarian and the faculty to instruct all students in the use of the library at the beginning of their medical studies. Similar statements may be found in the "Essentials of Approved Internships," "Essentials of Approved Residencies," "Essentials of an Acceptable School of Medical Technology," "Essentials of an Accredited School of X-Ray Technology," "Essentials of an Acceptable School of Occupational Therapy," "Essentials of an Acceptable School of Cytotechnology," "Essentials of an Acceptable School of Physical Therapy," "Essentials of an Acceptable School for Medical Record Librarians," and "Essentials of an Acceptable School for Inhalation Therapy Technicians." The medical library is likewise recognized as playing an important role in the continuing education of the practicing physician. An area, parenthetically, which you, Senator, have just discussed. The AMA's "Guide Regarding Objectives and Basic Principles of Continuing Medical Education Programs" cites the medical library as one of the important facilities which should be available to the physician-student. The current bill, S. 597, is based on the premises that the massive growth of knowledge in the health sciences in the past 20 years has not been matched by a growth of library facilities and techniques, and that much of the value of the knowledge and information may be lost unless proper measures are taken to develop the appropriate facilities and techniques. The American Medical Association is in agreement with these premises and believes that action should be taken to provide assistance in the construction of new facilities, the expansion and rehabilitation of existing facilities, the training of professional personnel and the development of new tools and methods for dissemination of medical knowledge and information. Evidence of the need for assistance is available from information gathered through the annual report of the AMA Council on Medical Education, published in the November 16, 1964, issue of JAMA and from a series of studies on the subject published in recent issues of the Journal of Medical Education. A comparision of the 87 existing medical school libraries with minimum standards recommended by a joint USPHS-AMA-AAMC committee (table I) showed that the average existing library was well below recommendations in space, volumes, and serial titles during the 1963-64 academic year. (Tables I and II follow :) TABLE I.-Comparison of existing libraries with recommended standards 1 From Medical Education Facilities, U.S. Department of Health, Education, and Welfare, Public Health Service, Publication 1180-A-1b, 1964. Review of the information provided by the 87 medical schools in existence during 1963-64 revealed startling variations in size and holdings among the various school libraries. The number of volumes held ranged from 2,000 to 359,000; the number of serial titles from 275 to 5,057. The range in annual budgets was from $13,000 to $382,101, and the number of full-time staff varied from a low of 1 to a high of 55. Details are given in table II. The CHAIRMAN. Quite a variation, Doctor. Dr. SODEMAN. Yes, it is quite a variation. It is clear from these figures that one should not make general statements about the condition of all medical school libraries. A few appear to be relatively very well off, while many others fall below the minimum standards recommended by the joint committee. Recent articles in the Journal of Medical Education have shown that expenditures for medical school libraries have not kept pace with the growth in their research expenditures, even though the marked increase in research activity has brought about greatly increased demands upon the library facilities. Similarly, the growth in complexity of activities in medical schools and hospitals has resulted in unusual demand upon the holdings and services of the medical library. Hosts of new professional, scientific, and technical personnel are seeking access to new kinds of scientific and medical information which many medical school libraries are simply not prepared to provide. As a result, there has been some impediment to the flow of productive research and to the availability of research information to professional practitioners. Detailed information on the current status of private, independent medical libraries, of those in community hospitals, and of those in State and county medical societies and other professional medical societies is not available to us at this time. The AMA is undertaking a study of the status and needs of medical libraries of state and county medical societies; but the results will not be available until later this year. The American Medical Association strongly supports the intent and purposes of S. 597. We will comment, however, separately on each of the substantive sections of the bill. SECTION 393-ASSISTANCE FOR THE CONSTRUCTION OF FACILITIES The American Medical Association supports the concept of the use of Federal funds for the construction of facilities. In implementing these provisions, we recommend that emphasis be given to the requirement that the construction meet demonstrated needs for additional or improved medical library facilities in the community or area. Properly favored, then, would be the provision of facilities in new medical schools and in currently underprivileged institutions; those in the lower category that you remarked about, Senator. In addition, we would hope that care would be exercised in the administration of the program, to prevent an overlap in grants with other Federal construction grant programs. SECTION 394-GRANTS FOR TRAINING IN MEDICAL LIBRARY SCIENCES We believe that there is a need for professionally trained personnel in medical library science and in related health science fields, as well as in the field of communication of information. The provision of grants for traineeships and fellowships and for the establishment of new training programs, both for new persons entering the field and to modernize and improve the skills and knowledge of persons already in the field, is most important and the American Medical Association supports this section wholly. SECTION 395-ASSISTANCE TO SPECIAL SCIENTIFIC PROJECTS, AND SECTION 396-RESEARCH AND DEVELOPMENT IN MEDICAL LIBRARY SCIENCE AND RELATED FIELDS Section 396 provides for grants for projects of research and investigation in the field of medical library science and for "the development of new techniques, systems, and equipment, for processing, storing, and retrieving and distributing information pertaining to sciences related to health." We believe this section to be of particular importance. Since emphasis is usually placed on space, budget, and library holdings, the important aspect of utilization is often overlooked. The critical factor in the value of a medical library is, after all, the question of how effectively its stored information is made available to the learner in response to his need. The largest and most magnificent library is of little value until its storehouse of information is actually in use. New methods of meeting the requirements of the learner more quickly and efficiently are badly needed, and we strongly support this section which is intended to develop such new methods. SECTION 397-GRANTS FOR IMPROVING AND EXPANDING BASIC RESOURCES OF LIBRARIES This section would provide the means for libraries to improve their holdings of books, journals, et cetera, and thus strengthen their basic resources and facilities. The provisions permitting acquisition of films, projectors, duplicating devices, and new technologic equipment are particularly valuable since most medical libraries are deficient in these areas. The AMA supports this section of the bill. SECTION 398-GRANTS FOR ESTABLISHMENT OF REGIONAL MEDICAL LIBRARIES The concept of having a strong medical library in each region of the country to serve as a source of support for other libraries in the area appears to be a very reasonable one under present conditions. The purpose of this section would seem to be best fulfilled by strengthening existing medical libraries in strategic locations to serve as regional libraries. Except in the unusual circumstances where a geographic area is completely lacking in library resources, new and separate regional libraries need not be established. SECTION 399-FINANCIAL SUPPORT OF BIOMEDICAL PUBLICATIONS We make no specific comment as to sections 395 and 399. However, the need for these provisions is less apparent to us. Mr. Chairman and members of the subcommittee, the American. Medical Association appreciates this opportunity of presenting its views on this important legislation. We will be pleased to attempt to answer any questions the committee may have. The CHAIRMAN. Doctor, we very much appreciate your presence and very much appreciate these views from the American Medical Association. I was naturally very much impressed with your statement |