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MONDAY, JUNE 22, 1964




Washington, D.C.

The subcommittee met, pursuant to notice, at 10 a.m., in room 1334, Longworth House Office Building, Hon. Kenneth A. Roberts (chairman of the subcommittee) presiding.

Mr. ROBERTS. The subcommittee will please be in order.

At this time Dr. Paul Peterson, Associate Chief for Operations, Bureau of States Services, Public Health Service, is here to testify as to the Department's position on H.R. 8546. Dr. Peterson had been here at the other hearing and as I understand the situation, was to go back to the Department and come back with some additional information. That was my understanding of the situation at the end of the last meeting.

We are very happy to have you, Dr. Peterson, and you may proceed with your statement.


Dr. PETERSON. Thank you, Mr. Chairman.

The hearings before this subcommittee on May 26, 1964, on H.R. 8522 and H.R. 8546, bills to amend title VII of the Public Health Service Act to extend to qualified schools of optometry and students of optometry those provisions thereof relating to student loan programs were recessed by the Chair with the request that the Department provide additional information regarding its recommendation against enactment of the legislation.

The Department policy regarding recommendations for special Federal assistance to students in various categories of health manpower is clear and consistent. Support of such student assistance is only recommended for those professional health categories wherein a clear and demonstrated need has been documented not only in terms of the numbers of the profession, but also in terms of jeopardy to the public health. Such jeopardy may be the result of long or short term serious lack of services, or may be the result of a shortage of trained manpower to exploit a scientific or technological breakthrough that would bring additional health benefits to our citizens.



Adequate manpower data have been accumulated in depth with respect to medicine and osteopathy, nursing, dentistry, and specialists in public health. The Public Health Service as a result has been able to conduct additional studies refining the evidence for presentation to the Congress. There is at the present time no study which identifies substantial unmet needs in the area of treatment of refractive errors and eye muscle disturbances.

Additionally the Department studies existing student assistance programs to determine whether they appear to be adequate to the needs of the students in the category under consideration. In the case of optometry students, evidence available to the Department indicates that the national defense educational assistance student loan program is meeting such needs and in fact has substantial latitude to meet even greater optometry student financial assistance than at the present time.

I would like now, with your permission, to expand on this policy statement with special reference to our negative recommendation on the legislation in question.

The question before us is not whether students of optometry should have Federal financial assistance in pursuing their education. That question has been answered, and such assistance is now being provided under the National Defense Education Act.

The question before us, stated very simply, is this: Is there a clear and demonstrated shortage of optometrists, so jeopardizing the health of the people of this Nation, as to warrant special assistance to students of optometry over and above that which is available to them under the National Defense Education Act? We have found such critical shortages in medicine and dentistry, in nursing, and in public health. To the best of our knowledge there has been no clear and documented evidence of such a shortage in optometry.

As you are aware, the PHS has for many years been concerned with the health manpower supply and requirement as they affect the health of the people of the Nation. From its general studies it has identified some of the key shortage categories, and moved to develop studies of those areas, with a view to long-range program recommendations to meet those documented needs. Such studies have identified critical shortages of physicians, dentists, public health personnel, and professional nurses, and the need both to increase the capacity of the teaching facilities and to provide special financial assistance to students in those categories. As a result of those studies, the Public Health Service has supported legislative proposals leading to the Health Professions Educational Assistance Act (Public Law 88-129) with provision for special loans for physicians and dentists, and to H.R. 10042 and H.R. 10043, bills for special Federal assistance in meeting shortages, respectively, of professional nurses and of professional public health personnel.

There are at present more than 30 recognized health professions and an even larger number of categories of subprofessional workers. The Public Health Service believes that legislation which would authorize special educational assistance in behalf of any of these health categories requires careful documentation of the following:

1. The present supply situation.

2. Trends in supply, and the outlook for future supply.

3. The present needs, demands, and the relationship of their numbers and skills to those of workers in related health occupations. 4. Expected future needs and demands.

5. The health effects of present and projected shortages.

6. The present training capacity in relation to need.

7. The availability of students in relation to need, and factors affecting the supply.

8. The adequacy of existing ways and means-public and privateof meeting any demonstrated needs.

At the present time we do not have data, for instance, on such necessary factors as (1) the incidence of eye disease in the general population, (2) the relative share of all eye disease represented by refractive errors and eye muscle disturbances, (3) the total number of persons in need of eye care, (4) the number of persons in need of eye care who are not receiving services, and the reasons that they are not receiving such service.

We are aware that the American Optometric Association is recommending a ratio of 1 optometrist to every 7,000 persons-or about 14 per 100,000-but, in the absence of the documentation of the essential factors noted above, we have no evidence to the validity of that projection.

Under the national defense education program, however, we do have information on the availability of student assistance and its adequacy to meet the financial needs of students of optometry. Although only 8 percent of the general student body in our colleges and universities received National Defense Education Act loans last year (1963), 14 percent of the optometry student body received such assistance, and this proportion was in spite of the fact that 3 of the 10 schools of optometry had not chosen to join the program. With the recent increase in the amount of Federal money available for National Defense Education Act student loans, which was raised from $90 million in fiscal year 1963 to $125 million in fiscal year 1964, with further increases anticipated in fiscal year 1965, the National Defense Education Act student loan program will have even greater resources on which to draw.

In my testimony to your committee on May 26, I mentioned some of the factors which underlie our belief that the National Defense Education Act student loan program is adequate to meet the financial needs of the optometry students, and that the special assistance of the Health Professions Educational Assistance Act is not indicated. One of these factors is in the comparative cost of medical or dental education as against optometry education. If we assume that the living cost of students is essentially the same, the difference in annual and aggregate costs may be measured in terms of (1) the costs of tuition and fees and (2) the number of years in the academic curriculum. For medical schools, the median annual tuition and fees in public schools is $558, resident, and $975 for nonresident students, and in private schools, $1.400. For schools of dentistry, the median annual tuition in public schools is $497 for residents, $938 for nonresidents, and $1,056 for private schools. For the schools of optometry, the median annual tuition is $270 for a resident and $500 for a nonresident in public

schools, and $825 for private schools. When we compare tuition and fees in schools of medicine, dentistry, and optometry in the same university, the difference in costs is in about the same order of magnitude. When we look at the length of training, we find training for optometry usually consists of 3 years at a school of optometry after 2 years of undergraduate college education-or 5 years in all. All schools are on this program except the University of Houston, where there is a 4-year program in the school of optometry, and it has been indicated that Ohio State University plans to initiate such a 4year program in the fall of 1964. Although there are a few schools of dentistry and medicine that will accept students with less than a baccalaureate degree, the competition for places in medical and dental schools makes 4 years of college work a practical requirement for admission. The professional academic course of dentistry and medicine requires 4 years, and an internship is required in medicine and recommended in denistry. This is a total of at least 8 or 9 years, compared with the 5 for optometry. Furthermore, most physicians serve a residency of from 2 to 4 years after completion of their internship.

Therefore, both in the annual costs of education and in the number of years required to complete the training, medicine and dentistry have substantially greater requirements than optometry.

Furthermore, both the average annual loan to students of optometry under National Defense Education Act in 1963, which was $628, and the total estimated need of such students are well below the maximum allowances of $1,000 per year and $5,000 total authorized under the National Defense Education Act.

The Health Professions Educational Assistance Act, as you know, provides that a loan does not become repayable until 3 years after the student ceases to pursue a full-time course of study. This provision was included, of course, because of the requirements of internship and residency. The National Defense Education Act loans become repayable in the year following the completion of the course of study, and we believe this is a more appropriate requirement for optometry which has no internship or residency.

We might also call to your attention that at the present time the interest rates under the National Defense Education Act are more favorable than those under the Health Professions Educational Assistance Act. As you know, the National Defense Education Act interest rate is 3 perecnt. The Health Professions Educational Assistance Act interest rate is 3 percent or the going Federal rate, whichever is higher; and at the present time is ranging between 37% percent and 41/4 percent. Since the Health Professions Educational Assistance Act specifically provides that as long as an eligible institution has an agreement to participate in its loan program no medical or dental student can receive a loan under the National Defense Education Act, therefore there would be no opportunity for a student to choose the lower interest rate if his school has embarked on a loan program under the Health Professions Educational Assistance Act. In summary then, our recommendation against enactment of these bills rests upon the following factors:

1. There has been no clear and documented evidence of a critical shortage of optometrists, such as to jeopardize the health of our citizens.

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