Now, the voluntary hospitals-there is an excellent program at St. Vincent's and the Beacon downtown. There is a splendid program at the Veterans' Hospital in White Plains. There is an excellent program in the Roosevelt Hospital. It is going clear through the whole hospital system.

Senator LEHMAN. How about the Medical Center and Mount Sinai? Dr. RUSK. Mount Sinai has just revamped their program and brought in a young man with Dr. Berman, and they are setting up such a program, and the Medical Center has had one for several years and is now associated with the crippled and disabled institute.

de

Senator LEHMAN. I assume those hospitals are experiencing the same difficulty in getting trained people to do this work as you scribed a little while ago?

Dr. RUSK. That is right.

Senator LEHMAN. I have been very much impressed by your whole statement, but I was particularly interested in that part of your statement which Senator Hill has already referred to, in which you

say:

I would like to emphasize, however, that the granting of these funds for research and training is an essential part of this proposed comprehensive program, for the other aspects of the program cannot be implemented unless we have additional trained rehabilitation workers to staff our expanded program. Now, under the leadership of Senator Hill a number of us for several years have been trying to secure funds to assist hospitals, medical schools, in the training of personnel, doctors, nurses, technicians, and other people, all of whom, I assume, from what you have said, are an essential part of any program for rehabilitation.

We have not succeeded in securing legislation for which we have been striving, and one of the arguments with which we have always been confronted is that there were enough doctors in this country.

Now, I doubt whether that is true. I am convinced that is not true. I am convinced there are not enough nurses in this country and, from what you have said, there are certainly not enough technicians to do this work, as well as to carry on many other aspects of medical care. I gathered that at least one of the bottlenecks in this program which you carry on is the lack of technically well-trained personnel.

I don't find anything in this bill that would provide additional resources or means for the training of the very people who are so necessary, according to your testimony, and I am quite sure that is accurate, to carry on this work.

I don't see how you are ever going to increase your case load and broaden your field unless you have additional personnel, trained personnel.

It doesn't make any difference how well intentioned people are; unless they are trained, they are not going to be able to do this job. I don't find anything in this bill that would increase the facilities for the training of personnel beyond what they are today.

Would you comment on that?

Dr. Rusk. I understood that the first year some million dollars would be available for implementing not for buildings, but for implementing of the program of training of ancillary personnel, and these seminar-type of training groups that would come in, teams that would come in, that there was that money in the allocation to the office here in Washington that would be avilable for that.

Maybe I misunderstood, but I understood there was some million dollars that would be available for this particular part of the program. Senator LEHMAN. How much?

Dr. RUSK. A million dollars.

Senator LEHMAN. I am not familiar with that; but, of course, a million dollars will not go very far.

The bills that have been introduced, as I say, largely under the leadership of Senator Hill, provided for assistance to existing medical colleges, and schools for the carrying on of the work which they have already undertaken. But what I consider a much more important phase of those bills is the incentive to the schools to train an increased number of people, which they can't undertake now because of lack of financial support.

In most cases, I believe the schools today are running a deficit even under existing circumstances.

So, there certainly is no likelihood, nor is there any encouragement given to believe that the schools are going to seek to train larger numbers of doctors and nurses and other people who must be trained technically and professionally in the work they are carrying on.

That is one thing I have not noted. There is no provision, as far as I know, in these bills that would effectuate that.

Dr. RUSK. I am speaking as an individual, but I am one who feels we do have a definite shortage of physicians, in addition to the isolated communities. It is said that is a geographic problem and not a general shortage, but when you think of the number of vacancies in mental hospitals and industrial physician vacancies, and vacancies in our public health institutions, and now the numbers that are going to be needed in this program, both in rehabilitation and the problem of the chronically ill-as I say, I am one who, personally, feels that we do have a shortage of physicians in this country.

Senator HILL. Excuse me.

A very considerable shortage, wouldn't you say?

Dr. RUSK. Yes; I think it is considerable.

Senator HILL. Not only that

Are you through, Senator?

Senator LEHMAN. I just want to emphasize one thing.

Senator HILL. I just want to bring this out: There is likewise such a shortage of medical technicians and nurses; isn't that true, Doctor? Dr. RUSK. Yes, sir.

Senator LEHMAN. You testified, I believe you said, there were 41 on your staff.

Dr. RUSK. In training.

Senator LEHMAN. In New York?

Dr. RUSK. That is right.

Senator LEHMAN. And that represents substantially half of those in the entire Nation?

Dr. RUSK. That is right.

Senator LEHMAN. Now, unless you take means to make possible the training of a greatly increased number of personnel, how are you ever going to in any measure carry on the work that you feel is necessary, and which I feel is very greatly necessary and very greatly in the interest of the Nation, as well as for the individual?

It seems to me unless such steps are taken to that end, the progress in education and training is going to be very, very seriously retarded.

Senator HILL. I would like to ask one other question.

Senator PURTELL. I am sure all of the members of the committee are free to ask questions, as many as you wish.

Senator HILL. Doctor, as I recall, you wholeheartedly supported the 2 bills for aid to medical education, which this committee reported out, 1 of which was passed by the Senate; isn't that true?

Dr. Rusk. I didn't testify on those bills.

Senator HILL. You didn't testify?

Dr. RUSK. No, sir; but I have been one who has felt we have had not only a shortage of physicians, but something needed to be done with the level of salaries of medical teachers, which I think is one of our real problems at the present time. It is far below that of those in practice.

I think when you go into the academic life you don't go in for monetary gain, but you have to have a certain amount if you are going to be able to raise and educate your family.

When you see young men struggling along on below-living salaries and trying to raise their children and do teaching and research, I think it is a very discouraging facet of the situation.

Senator PURTELL. Have you any other questions, Senator Lehman? Senator LEHMAN. No.

Senator COOPER. May I ask one question?

Senator PURTELL. Senator Cooper.

Senator COOPER. Admitting the great interest and importance of the subject which Senator Lehman and Senator Hill have raised, and its necessity, would you say that the development of facilities could have some effect in attracting doctors into this field?

Dr. RUSK. Yes; I think it would. Definitely.

Senator COOPER. And isn't it true even if there were a much larger number of doctors in this field there would still exist the problem of their location for their work, and that the establishment of facilities throughout the country would have an effect in the distribution. of doctors for this work?

Dr. RUSK. That is right.

Senator COOPER. It is true, isn't it, that one reason doctors will not go into isolated localities, rural localities, is that there are not hospital facilities which enable them to progress and go on with their work, and study as they practice?

Dr. RUSK. I believe that to be true; yes.

Senator COOPER. Do you think, then, that this bill, even though it may be limited, would have effect upon increasing the interest and training of doctors for this field, and also direct their distribution?

Dr. RUSK. I don't think it would help in the isolated communities because I believe these have to be in areas where good medical care exists, and this is in addition to it.

I think it would be a mistake to put a rehabilitation center in an isolated community because they wouldn't have the ancillary help and the problem of transportation of other disabled people throughout the State, and that sort of thing would be difficult. However, I think it would definitely help in interesting the members of the profession in this specific specialty.

Some feel we are reaching pretty much the saturation point in surgery. For example, the problems in surgery have changed, with

antibiotics, and so forth and so on. They have broadened in other fields; but it has been a great, interesting field for young physicians, and the field of chronic disease, which is now on our back, whether we like it or not, has not seemed as glamorous as some of the others.

So, I think facilities work, where you can see results, where you can get your patients up and walking and back in life again, will give great incentive to many young men to come in and be a part of such a program.

Senator COOPER. Even though the program we are now talking about and the program which is set out in this bill may be a limited program, perhaps deficient in respect to doctors, would you still recommend that the bill be enacted even though this deficiency is recognized?

Mr. Rusk. I think it is a wonderful start for us.

Senator COOPER. That is all I have.

Senator PURTELL. I think-thinking along the same line that Senator Cooper has expressed himself-I might want to ask this question: Do you know of any facilities today for the particular specialized type of work that you are in, Doctor, that are not staffed because people aren't attracted to them?

Isn't there a shortage of facilities rather than of personnel?

Dr. RUSK. A shortage of both.

Senator PURTELL. But do you know where you have facilities you lack the personnel?

Dr. RUSK. Yes, sir.

Senator PURTELL. You do?

Dr. RUSK. Yes, sir.

Senator PURTELL. In large numbers?

Dr. RUSK. Rocky Hill, Conn., is one.

Senator PURTELL. Rocky Hill is peculiar.

I think you and I might have a little talk on the side about Rocky Hill.

Dr. RUSK. But I know they are looking for physicians there in Rocky Hill, and also they just took one of my very top young physi

cians.

Senator PURTELL. That is a Veterans' facility.

Dr. RUSK. At Rocky Hill?

Senator PURTELL. Yes.

Dr. RUSK. It is both community and Veterans' now, isn't it?

Senator PURTELL. Mostly Veterans'. It was a State-established institution.

Dr. RUSK. But the facility down at Fisherville has had great difficulty in filling their professional needs.

The Jewish Hospital in St. Louis right now, with the plans for expansion, and so forth, are frantically looking for someone to come out and head their program.

The Institutes of Health here in Washington-one of my young doctors is just coming down to head that facet of the program here, which hasn't been covered heretofore.

When a great institution of America which has been in the field of research and training has been short and had difficulty in finding someone to head such a program, I think it shows you how difficult

Senator PURTELL. Are there any other questions?

Senator LEHMAN. I would emphasize the fact, according to your testimony, you have 41 trained men, half the number in the country; so, that would mean there are 80 to 100 trained people who are available at the moment and, yet, I think you have testified there are about a million and a half or two million physically handicapped, and that number is growing at the rate of 250,000 a year.

I don't think it will make much of a dent on that number of people, or even half that number, or a quarter of that number of the people, with the very limited trained personnel that appears to be available.

Dr. RUSK. We can make a real start, I think; but then if we can demonstrate what we can do in the next year and how this thing has grown and the people are being placed, and that we have wisely worked in this field, I think we would be entitled to come and say, "We could do this with this the next year," but I don't think we could move any faster than this in this next year. I really don't.

Senator LEHMAN. But, Doctor, I want to make it very clear that I am wholeheartedly and completely in sympathy with the program of rehabilitation. My only criticism is that what is proposed now doesn't go nearly far enough and that, while it would be a start, I would like to see the start intensified in tempo, so that we would make progress much more rapidly than appears to be likely in the present circumstances.

Dr. RUSK. That would be fine for me, sir. We will move as fast as

we can.

Senator PURTELL. Unless there are other questions, I want to thank you again, Dr. Rusk, for coming here and testifying as you have. You have helped us a great deal, and your statement will be inserted in the record in full at the end of the testimony you have given.

Thank you again, Doctor.

Senator HILL. Mr. Chairman, may I add to what you have said in appreciation to Dr. Rusk. Here is a man who is doing a wonderfully fine, really pioneering job, and he has made a mighty contribution, I think, to the health, the happiness, and the economic welfare of so many people in our country.

Dr. RUSK. Thank you, sir.

Senator LEHMAN. I would like to associate myself with your remarks, Senator Hill.

Senator PURTELL. So would I, and I am sure if the other members of the committee were here they would wish to be associated with those remarks.

Dr. RUSK. Thank you.

Senator PURTELL. Thank you, Dr. Rusk.

Is Dr. Emory Morse, President of the Kellogg Foundation of Battle Creek, Mich., here?

He isn't here.

Then we will notify the doctor, if he wishes, that he can have his statement, if he wishes to submit it, inserted in the record.

Now we have Dr. John R. Rodger of the rural medical service committee of the Michigan State Medical Society, and, Dr. Rodger, we would like very much to have you help us in our deliberations.