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Dr. PETERSON. There are also studies that are being supported in the community health services and facilities project grant program dealing with special problems of the aged and their care, in regard to eye disease as well as other physical disablement.

Mr. ROGERS of Florida. Now, can you submit to this committee a list of those studies, who is conducting them, under whose jurisdiction, and when they will be completed, when it is anticipated we can have the results?

Dr. PETERSON. We would be happy to submit that for the record. (The information requested appears beginning on p. 173.)

Mr. ROGERS of Florida. I think that would be helpful, and what you expect to find. In other words, if it is a study on the need for eye care, and so forth.

Let me ask you this. Does the Department agree that optometry is a necessary medical aid to the people or not? What is the official position on this? It appears to me you do not even want to recognize optometry. What about it?

Dr. PETERSON. I hope that that has not been the impression we have given to you, sir, because so far as the Department is concerned, optometry is a healing profession licensed by all of the States and territories, and we have never taken any position other than that in terms of projects that have been awarded or other activities that have been undertaken by the Department.

Mr. ROGERS of Florida. Has HEW ever hired an optometrist who is employed to do the job of an optometrist?

Dr. PETERSON. Yes, sir. Mr. ROGERS of Florida. Will you tell us who they are? Dr. PETERSON. Well, I am not familiar with all such. I answered with a great deal of assurance because a friend who is an optometrist is employed out at the National Institutes of Health.

Mr. ROGERS of Florida. To do the job of an optometrist.
Dr. PETERSON. That is correct.

Mr. ROGERS of Florida. Which is mainly concerned with refraction, and so forth.

Dr. PETERSON. Research in refractive problems.

Mr. ROGERS of Florida. Suppose you supply us a list of who you have hired. I do not think it would too large a job from what I understand. I do not think there will be too many.

Dr. PETERSON. All right.
(The information requested appears on p. 173.)

Mr. ROGERS of Florida. And I know you have some ophthalmologists.

Dr. PETERSON. Yes. We have some.

Mr. ROGERS of Florida. Are you doing any training of assistants in refraction!

Dr. PETERSON. There are two projects that have been awarded, one to Georgetown University Medical School and the other to New York University for the development of a curriculum that would provide training for ophthalmological assistants to work in offices of ophthalmologists. The curriculum would envision nurses or college graduates who would want to take this type of special training to assist the ophthalmologist in his office. The two projects have only been underway for about a year, and we have not been able at this time to

assess whether or not this is a valid type of program. It will be some time before we know what the status of that effort might be.

Mr. Rogers of Florida. What do you mean you do not know whether it is a valid program?

Dr. PETERSON. Just as with the training of any technical assistants, such as the X-ray technician, to help the specialist in developing and in the taking of films, in the operation of the X-ray department. Before it is possible to know exactly the type of training or what the use of these people might be, it is necessary to go through a period of experimentation. The same was done with dental assistants and chairside assistants in the dental profession before this type of training was more broadly supported by the dental schools. We also went through a similar period of experimentation before the licensed practical nurse found her place in the spectrum of professional nursing service as a technical aid to the professional nurse herself.

Mr. Rogers of Florida. Well, are these optometrists, then, that are training

Dr. PETERSON. No, sir.
Mr. ROGERS of Florida. To be of assistance?

Dr. PETERSON. They will not be licensed. They will not be licensed health professionals. Only technical.

Mr. ROGERS of Florida. But they will do the work in refractory work, refraction. Work on refraction.

Dr. PETERSON. They might in some instances do work for the physician in measuring refractive problems, or do other work in his office, depending on what work the physician might assign.

Mr. Rogers of Florida. The optometrist profession says the ratio now is about 1 optometrist to each 11,250 persons, that there is now a shortage of 10,000 optometrists and the ratio should be 1 to 7,000. What is your comment on that?

Dr. PETERSON. As we indicated, at the present time we have no basis upon which to either accept or reject this as a valid goal.

Mr. ROGERS of Florida. Even with the figures that they have presented in their testimony here showing the shortages, and so forth.

Dr. PETERSON. It might be that this is an inadequate goal. It might be that it is more optimistic than would be required. Mr. ROGERS of Florida. Well, let me ask

you
this. Have

you

done studies in opthalmology?

Dr. PETERSON. No, sir.

Mr. Rogers of Florida. Did you recommend that they be included in the health bill?

Dr. PETERSON. Only basic training for physicians; this was all that was provided. No special mention was made of any of the specialties of medicine.

Mr. ROGERS of Florida. No mention was made of any specialty of medicine?

Dr. PETERSON. No, sir.

Mr. Rogers of Florida. But they are included, of course, in the medical aid bill.

Dr. PETERSON. During their undergraduate training, not for their specialized training.

Mr. Rogers of Florida. Do you think it is more difficult for a medical student to get aid for his education than for, say, a student of optometry?

Dr. PETERSON. At the present time, with our hoping that the health professions student assistance loan program will begin with the next academic year, it would be my feeling that this loan program plus the loan program of the American Medical Association plus loan programs that are available in a number of the schools from private sources would probably meet the major loan requirements of most students in medical and dental schools. This may not be the case. On the basis of some recent studies by the American Association of Medical Colleges, it may be that we are not as favorably situated as this statement might indicate to you, but this is my best judgment at the present time.

Mr. PICKLE. I would like to ask you this question, Dr. Peterson, since we are on this subject. Isn't the Health Professions Assistance Act designed primarily to give assistance through the academic professional years only?

Dr. PETERSON. Only. For the 4 years of academic professional education,

Mr. PICKLE. That would include dentistry, medicine!
Dr. PETERSON. Very specifically it includes dentistry.
Mr. PICKLE. Optometry?
Dr. PETERSON. No, sir; it does not include optometry.
Mr. PICKLE. But it was for the academic years only.

Dr. PETERSON. That is correct. It does not include the preprofessional years of training, nor the postgraduate training.

Mr. ROGERS of Florida. Now I take it from your testimony, HEW really does not know anything about the eye care that is needed by the American people nor what eye care is really being supplied in regard to America. Would that be a true statement ?

Dr. PETERSON. We do not have accurate data in that regard, that is correct.

Mr. ROGERS of Florida. And, yet, some of the professions have been included in the aid bills.

Dr. PETERSON. I am sorry, sir. I did not

Mr. ROGERS of Florida. Well, ophthalmologists, undergraduate work. They have been included in that medical assistance bill.

Dr. PETERSON. Only insofar as it is necessary that an individual have his M.D. degree before he may engage in graduate training that would envision his certification and

designation as an ophthalmologist. There is no provision in the Health Professions Assistance Act that would assist in the specialized training of such a physician.

Mr. ROGERS of Florida. Now let me ask you this: Is there anyone in HEW who has the responsibility in their division of the eye care of the American people? Do you have it broken down that way, anyone who has charge of ophthalmology, optometry, and so forth?

Dr. PETERSON. No, sir.
Mr. ROGERS of Florida. There is no such division.
Dr. PETERSON. We have no such categorical program.
Mr. ROGERS of Florida. What does it fall under ?

Dr. PETERSON. It falls under two principal places in the Public Health Service. The research interests fall within the National Institute of Neurological Diseases and Blindness as this is the research arm which deals with this general project.

Mr. ROGERS of Florida. And how long has that been in existence?

Dr. PETERSON. I am sorry, sir. I would have to furnish that for the record.

Mr. Rogers of Florida. Well, approximately. You can furnish the exact time for the record, but what would you say, approximately?

Dr. PETERSON. Oh, that approximately is 10 years.
Mr. ROGERS of Florida. Ten years.

Dr. PETERSON. And the program that addresses itself to the promotion of neurological and sensory disease preventive services is in the Bureau of State Services. This was first made an active program branch 18 months ago.

Mr. ROGERS of Florida. So for 10 years we have had this division but no survey has been done, no study to determine the need.

Dr. PETERSON. No, sir. Not to my knowledge.
Mr. BROTZMAN. Will the gentleman yield?
Mr. ROGERS of Florida. Yes.

Mr. BROTZMAN. Just one or two questions. Doctor, have you had an opportunity to hear some of the other witnesses that have appeared before this committee?

Dr. PETERSON. Yes, sir. We were here.

Mr. BROTZMAN. Now, it is my recollection that most of them testified as to a need. Are you in a position to rebut their particular testimony in this regard ?

Dr. PETERSON. No, sir.

Mr. BROTZMAN. You have no facts or figures that would tend to discredit their particular testimony. Is this correct?

Dr. PETERSON. That is correct.
Mr. BROTZMAN. I have no further questions.
Mr. ROBERTS. The gentleman from Texas?

Mr. PICKLE. Dr. Peterson, I compliment you on your very frank answers, although they seem somewhat general. I suppose you just actually came to say that you cannot establish a need either

way. The statement has been definitely made that there is a need for some 10,000 optometrists. You do not say whether this is too many or too little. I think you have just said that it can be either way.

Dr. PETERSON. That is correct, sir.

Mr. PICKLE. Yet in the face of that you tell us that optometry, then, should not be included under this bill because there is no need for further training of optometrists. Now, how can you say that there might be a shortage and yet there is no need?

Dr. PETERSON. I am sorry, sir, if I gave the impression that I was saying there was no need for further training of optometrists. This I did not intend to give as an impression. As a matter of fact, I would like to be sure that the committee understands that we do feel that the schools are doing a good job. We have only indicated that it is our feeling that there is a loan program available to the students of optometry that can meet their needs insofar as we are able to determine them, that it does have capacity to increase their participation if they show evidence of greater need, and that certainly if there should come a time when it would appear that this particular loan program was inadequate, I am sure the Department would bring that evidence before the committee.

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Mr. PICKLE. Now, if 14 percent of the student loans go to optometry students, this would be 14 of the total 8 percent of students; is that correct?

Dr. PETERSON. No. Let me clarify that. Of all students in colleges and universities, approximately 8 percent on the average borrow under the National Defense Education Act program. Of all of the students who are in schools of optometry, there are approximately 14 percent who have borrowed or did borrow in 1963 from the National Defense Education Act program.

Mr. PICKLE. Well, would you not say this is an indication that there was a need for further training, a desire for the study of optometry, and in turn there is a need for them? Would this high percentage show that there is an interest in the need for this profession?

Dr. PETERSON. Well, it certainly indicates that among the students who are in optometry schools, they do have requirements for financial assistance as measured by this data. I think that the question that you pose is better answered by the fact that there are about 1,400 individuals who are full-time students of optometry, and obviously this number of students in our Nation is an indication of considerable interest on the part of academically qualified individuals and certainly is an indication of the stimulation that they see in the future for this particular professional pursuit.

Mr. PICKLE. Well, if there is a shortage of optometrists and you concede that there exists a very definite possibility, what yardsticks would the Department use in determining whether there is a shortage in the profession? Dr. PETERSON. There were the Mr. PICKLE. Any one of the professions.

Dr. PETERSON. These were the items listed in our statement in addition to the numbers of individuals presently in the profession; the trends in supply, outlook for the future, present needs and demands in relationship to those workers in related health occupations that could be expected to mutually handle a particular disease problem (examples of this are the physiatrists, those specialists in rehabilitation medicine and physical therapists, and in this particular context it would be the optometrists and the ophthalmologists both dealing in this problem area), expected future demands, the health effects of present shortages, and the availability of students in relation to need and the adequacy of existing ways and means, public and private, for meeting such demonstrated needs.

Mr. PICKLE. Dr. Peterson, you listed approximately eight or nine criteria that you base the needs on, study of needs for optometrists. Now, have you presented this criteria to the optometrical profession? Have you asked them for their advice and counsel as to whether these needs have been met ? Have you ever consulted with them?

Dr. PETERSON. I am sorry. I am not able to answer that question. I personally have not. Whether or not these have been reviewed in a general way or specifically with the profession, I cannot answer.

Mr. PICKLE. Well, let me ask you one or two more questions. Optometry loans are available now under the National Defense Education Act.

Dr. PETERSON. That is correct.

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